Practice patterns of pneumatic retinopexy in the United Kingdom
- Mr A Assi
- Accepted 11 August 2000
Editor,—Pneumatic retinopexy (PR) has been the subject of one multicentre randomised controlled trial12 and many uncontrolled studies with reported success rates with one procedure of 53–84%.34 In a retrospective review of 31 cases published in 1999, we reported a primary reattachment rate of 61% with this procedure, with a relatively high incidence of secondary breaks and proliferative vitreoretinopathy.5 Because of these variable success rates, PR is viewed as controversial by many surgeons. We conducted a postal survey to estimate the acceptance and prevalence of PR for the treatment of primary rhegmatogenous retinal detachment among vitreoretinal surgeons in the UK.
Questionnaires were posted in July 1999 to 80 members of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS). We questioned the number of PR procedures they performed per month, their reasons for selecting it as a first procedure, and their estimated primary success rates. The data were collected anonymously.
RESULTS
A total of 69 questionnaires were returned (86%). Thirty (43%) of the 69 vitreoretinal surgeons indicated that they never perform PR, 28 (41%) use it occasionally (less than once a month), and only 11 (16%) surgeons use it frequently (one to four times a month).
Surgeons who don't perform pneumatic retinopexy A third of the surgeons who don't perform PR said that they had tried it in the past and abandoned it. Ninety per cent of these surgeons believe that pneumatic retinopexy has a lower reattachment rate than other techniques and a third associate it with a high rate of complications.
Surgeons who perform pneumatic retinopexy occasionally The mean success rate of the 41% surgeons who perform PR occasionally is estimated at 73% (SD 20.2). Their main indications for using this procedure are patient unfit for more invasive surgery (70%), simplicity and ease of the technique (53%), and the lack of theatre time or anaesthetic cover (32%).
Surgeons who perform pneumatic retinopexy frequently The 16% of surgeons who said that they perform PR frequently estimate their success rate at 80% (SD 8.8). The simplicity and ease of the procedure is their main reason for using it (82%). Other reasons include its high success rate for primary reattachment (64%) and patients unfit for more invasive surgery (55%).
COMMENT
This study demonstrates that pneumatic retinopexy is not popular as a first procedure in the treatment of primary rhegmatogenous retinal detachment among most vitreoretinal surgeons in the UK. A survey conducted in North America and published in 19936 revealed the selective use of this technique among American vitreoretinal surgeons with geographic pockets of increased use in California and Florida. A more recent survey confirmed these regional differences and demonstrated an increase in the popularity of PR among younger retinal specialists.7
