Inverted pneumatic retinopexy: A method of treating retinal detachments associated with inferior retinal breaks

doi:10.1016/S0161-6420(02)01896-1

Ophthalmology

Volume 110, Issue 3, March 2003, Pages 589-594

https://doi.org/10.1016/S0161-6420(02)01896-1 Get rights and content

Abstract

Purpose

To introduce the new approach of inverted pneumatic retinopexy for the management of rhegmatogenous retinal detachments with inferior retinal breaks.

Design

Retrospective, noncomparative case series.

Participants

Eleven patients presenting with rhegmatogenous retinal detachments with causative inferior retinal breaks.

Intervention

Sterile gas/air injection, cryopexy/laser retinopexy, with inverted positioning.

Main outcome measures

Postoperative primary and final anatomical outcome, visual acuity, and complications.

Results

Patients were followed for a minimum of 3 months (mean, 5.1 months). Primary retinal reattachment was obtained in 10 of 11(91%) patients. One patient sustained a redetachment secondary to proliferative vitreoretinopathy, resulting in a single operation reattachment rate of 82%. Final reattachment was obtained in 11 of 11 (100%) patients. Mean visual acuity improved about 3 lines from 20/60 to 20/30, with 11 of 11 patients experiencing improvement in their visual acuity. Two patients required an additional surgical procedure to achieve final anatomic success. No new breaks were identified in the postoperative period, and no complications resulted from the pneumatical procedure.

Conclusions

Inverted pneumatic retinopexy can successfully repair retinal detachments with inferior retinal breaks under appropriate conditions.

Section snippets

Patients and methods

A retrospective review of the medical records of one clinician’s practice (TSC) identified 11 patients who had undergone pneumatic retinopexy for rhegmatogenous retinal detachments with inferior retinal tears between July 1, 1997, and December 31, 2000. Patients with inferior retinal tears were not recruited for this study in a consecutive manner. All patients were advised of the options of inverted pneumatic retinopexy, scleral buckling, or vitrectomy. After discussion of the head positioning

Results

The mean patient age at presentation was 45.9 years (range, 24–71), with eight men and three women included in the study. All patients were followed for a minimum of 3 months after inverted pneumatic retinopexy, with the mean follow-up period being 5.1 months (range, 3–15). Three of the patients had previously undergone scleral buckle surgery for a primary retinal detachment (cases 1, 2, and 5). Two patients had recently been treated for a superior retinal detachment with pneumatic retinopexy

Comment

Although the initial report of a “pneumatic” retinopexy for rhegmatogenous retinal detachments was published by Ohm in 1911,10 modern pneumatic retinopexy techniques were first popularized by the Hilton and Grizzard study published in 1986.1 At this time, scleral buckling had become the procedure of choice for primary, uncomplicated retinal detachment. However, over the next 15 years, the popularity and role of pneumatic retinopexy grew enormously. A recent survey of Vitreous Society members

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Cited by (44)

Pneumatic retinopexy: A critical reappraisal
2021, Survey of Ophthalmology
Pneumatic retinopexy (PR) has been widely advocated for treatment of selected rhegmatogenous retinal detachments: those with small, anterior, superior, retinal breaks and little or no proliferative vitreoretinopathy. It has been suggested that PR is underused and is advantageous because it is an outpatient clinic or office procedure, short in duration, nonincisional, and cost saving – with reduced perioperative morbidity, faster postoperative recovery, better and faster visual recovery, a low rate of complications and a high rate of overall success compared with scleral buckling or pars plana vitrectomy. We reevaluated these advantages to substantiate the effectiveness and efficiency of PR and critically define its role in the treatment of rhegmatogenous retinal detachment. We found that PR has a much higher rate of subsequent reoperation and proliferative vitreoretinopathy than scleral buckling or pars plana vitrectomy for simple, good prognosis rhegmatogenous retinal detachments. PR often involves multiple procedures that largely negates its potential cost savings and subjects the patient to prolonged stress and disability. Scleral buckling rather than PR is ideally suited for simple, good prognosis rhegmatogenous retinal detachments for surgeons who feel comfortable with the technique; alternatively, pars plana vitrectomy is indicated.
Anatomic, Visual, and Financial Outcomes for Traditional and Nontraditional Primary Pneumatic Retinopexy for Retinal Detachment
2019, American Journal of Ophthalmology
To determine factors predictive of anatomic, visual, and financial outcomes after traditional and nontraditional primary pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RD).
Retrospective interventional case series and cost comparison.
Participants: Total of 178 eyes (156 patients) with PR-repaired primary RD by a single surgeon at a clinical practice from January 2001 to December 2013 and followed for ≥1 year. The cohort had 2 subgroups: traditional (TPR) and nontraditional (NTPR) PR. Main Outcome Measures: Characteristics associated with best-corrected visual acuity (BCVA) and anatomic outcomes. Cost analysis and potential cost savings comparing PR to scleral buckle and vitrectomy.
One hundred thirty-one of 178 eyes (73.5%) were successfully treated at 1 year (postoperative year 1): 72.8% (75/103) in TPR and 74.6% (56/75) in NTPR. Macula-off detachment (−0.44 logMAR, P < .001) and clock hours of RD (−0.84 logMAR, P < .001) correlated with improved BCVA; pseudophakia (0.26 logMAR, P = .002) and inferior retinal tears (0.62 logMAR, P = .009) correlated with worsening BCVA. Pseudophakia (−0.15, P = .03), inferior quadrant RD (−0.27, P < .001), and proliferative vitreoretinopathy (−0.68, P < .001) correlated with anatomic failure. Total average cost for TPR and NTPR was $1248.37 ± $882.11 and $1471.91 ± $942.84, respectively (P = .10). PR had a potential cost savings of 62% and 60.8% when compared to scleral buckle and vitrectomy, respectively.
PR results in successful anatomic and visual outcomes in both TPR and NTPR repair of primary RD. Preoperative pseudophakia is associated with worse visual outcomes and less anatomic success. The cost of primary PR and subsequent procedures to achieve final anatomic success was not significantly different between TPR and NTPR, and supports the possible cost-effectiveness of expanded indications for PR.
Recent Progress in Using Biomaterials as Vitreous Substitutes
2015, Biomacromolecules
Vitreous substitutes are crucial adjuncts during vitreo-retinal surgery for retinal diseases such as complicated retinal detachment, macular holes, complications of diabetic retinopathy, and ocular trauma involving posterior segment. In retinal detachment surgery, an internal tamponade agent is required to provide internal pressure for reattachment of the detached neurosensory retina. Current available options serve only as a temporary surgical adduct or short-term solution and are associated with inherent problems. Despite many years of intensive research, an ideal vitreous substitute remains elusive. Indeed, the development of an ideal vitreous substitute requires the concerted efforts of synthetic chemists and biomaterial engineers, as well as ophthalmic surgeons. In this review, we propose that polymeric hydrogels present the future of artificial vitreous substitutes due to its high water composition, optical transparency, and rheological properties that closely mimic the natural vitreous. In particular, thermosensitive smart hydrogels, with reversible sol to gel change, have emerged as the material class with the most potential to succeed as ideal vitreous substitutes, facilitating easy implementation during surgery. Importantly, these smart hydrogels also display potential as efficacious drug delivery systems.
Scleral buckling for inferior rhegmatogenous retinal detachments
2014, Journal Francais d'Ophtalmologie
L’objectif de notre étude est d’étudier les aspects épidémiologiques, cliniques, thérapeutiques et pronostiques concernant les cas de décollements de rétine (DR) rhegmatogènes inférieurs opérés par cryo-indentation.
C’est une étude rétrospective des cas de DR rhegmatogène intéressant les quadrants inférieurs uniquement avec déhiscences inférieures (4–8 h), opérés par cryo-indentation dans notre service de 2006 à 2011. Ont été analysés : le profil épidémiologique des patients, le statut réfractif, le délai de consultation, les données de l’examen clinique, les modalités thérapeutiques ainsi que les résultats fonctionnels et anatomiques.
Quarante-cinq cas sont inclus dans cette étude (45 yeux), l’âge moyen des patients est de 44,5 ans (de 14 à 75 ans), avec une légère dominance masculine (56 %). La myopie est constatée chez 60 %. Le délai moyen de consultation est de 3,5 mois. L’acuité visuelle à l’admission est inférieure à 1/10 dans 53,33 %. Le soulèvement maculaire est constaté dans 80 %. Les lésions causales sont dominées par les trous dans 26 yeux. La prolifération vitréo-rétinienne est essentiellement stade B dans 48,9 %. La cryo-indentation est pratiquée chez tous les malades et la ponction du liquide sous-rétinien chez 37,8 %. La réapplication rétinienne est obtenue chez 36 yeux (80 %) avec une acuité visuelle finale supérieure ou égale à 1/10 chez 71,11 %. Le suivi moyen est de 6,62 mois.
Le DR inférieur touche avec prédilection les myopes jeunes. Le délai de consultation est souvent long et le traitement chirurgical par voie externe, bien que difficile, s’avère efficace.
To investigate the epidemiological, clinical, therapeutic and prognostic factors in cases of inferior rhegmatogenous retinal detachments (RD) treated by scleral buckling surgery.
A retrospective chart review was performed on 45 patients (45 eyes) with inferior RD with only inferior tears (4:00–8:00), who had been treated by scleral buckling surgery over a 6-year period from 2006 to 2011. The parameters studied included patient demographics, refractive status, time until consultation, clinical exam data, treatment modalities and functional and anatomic results.
Forty-five cases were included in this study (45 eyes), with an average patient age of 44.5 years (14 to 75 years) and a slight male predominance (56%). Myopia was observed in 60%. Mean time until consultation was 3.5 months. Visual acuity on admission was less than 1/10 in 53.33%. Macular detachment was found in 80%. Causative lesions were holes in 26 eyes. Proliferative vitreoretinopathy was essentially stage B in 48.9%. Scleral buckling surgery was performed in all patients, with drainage of subretinal fluid in 37.8%. Retinal reattachment was obtained in 36 eyes (80%) with a final visual acuity greater than or equal to 1/10 in 71.11%. The mean follow-up in our study was 6.62 months.
Inferior retinal detachment has a predilection for young myopes. The time until consultation is often long, and extraocular surgery, although difficult, exhibits documented efficacy.
Predictors of treatment failure for pneumatic retinopexy
2013, Canadian Journal of Ophthalmology
The purpose of this study was to define the overall anatomic success rate in pneumatic retinopexy and to identify morphologic features that may be predictive of treatment failure in pneumatic retinopexy.
Prospective consecutive interventional case series of patients with new-onset primary rhegmatogenous retinal detachments treated with pneumatic retinopexy.
In this interventional case series, consecutive patients with new-onset primary rhegmatogenous retinal detachments were treated with pneumatic retinopexy and followed prospectively. Morphologic data were collected on 3-colour fundus drawings. The primary outcome measure was treatment failure, defined as requirement for scleral buckle or vitrectomy within the follow-up period. Rates of failure for each morphologic feature were compared and a logistic regression model was fit.
A total of 113 eyes were included in the study. Anatomic success was achieved in 69.6% of patients. Morphologic criteria including the position and number of breaks, position and extent of lattice degeneration, size of the detached area, and macular status were all found not to be significantly related to failure. In multivariate analysis, only 3 predictors, pseudophakic status (p < 0.05, odds ratio [OR] 2.9, 95% CI, 1.06–7.88), presence of retinal break greater than 1 clock-hour (p < 0.05, OR 3.41, 1.06–11.02), and presence of grade C or D proliferative vitreoretinopathy (PVR) (p < 0.01, OR 31.83, 95% CI, 3.59–282.24), gained statistical significance.
Only pseudophakia, a large retinal break, and/or PVR was associated with an increased likelihood of failure.
Cette étude a pour objet de définir le taux global de réussite anatomique de la rétinopexie pneumatique et d'identifier les caractéristiques morphologiques qui peuvent être prédictives d'un échec du traitement par rétinopexie pneumatique.
Dans cette série de cas d'intervention, les patients consécutifs ayant une survenue de nouveaux décollements de la rétine rhegmatogène avaient été traités par rétinopexie pneumatique et suivis de façon prospective. Les données morphologiques ont été colligées sur des dessins en 3 couleurs du fond d'œil. Le résultat primaire était l'échec du traitement défini comme étant la nécessité d'une boucle sclérale ou de la vitrectomie durant la période de suivi. Les taux d'échec de chaque marque morphologique ont été comparés et l'on a installé un modèle de régression logistique.
L'étude a porté sur 113 yeux. La réussite anatomique a été atteinte chez 69,6% des patients. Aucun des critères morphologiques, comprenant l'emplacement et le nombre des ruptures, la position et l'étendue des treillis, la taille de l'aire détachée et l'état maculaire, n'a été trouvé relié de façon significative à l'échec. Dans l'analyse à variables multiples, seulement trois prédicteurs, l'état pseudophake (p < 0,05, 2,9 [1,06, 7,88]), la présence de déchirure rétinienne au-delà d'une heure d'horloge (p < 0.05, 3,41 [1,06, 11,02]) et la présence de vitréorétinopathie proliférative (VRP) de grade C ou D (p < 0,01, 31,83 [3,59, 282,24]), ont obtenu une signification statistique.
Seules la pseudophakie, une grande déchirure rétinienne et/ou la VRP étaient associées à l'augmentation des possibilités d'échecs.
Short-term external buckling with pneumatic retinopexy for retinal detachment with inferior retinal breaks
2013, American Journal of Ophthalmology

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Inverted pneumatic retinopexy: A method of treating retinal detachments associated with inferior retinal breaks☆

Abstract

Purpose

Design

Participants

Intervention

Main outcome measures

Results

Conclusions

Section snippets

Patients and methods

Results

Comment

A two-step outpatient operation without conjunctival incision. Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Trans Am Ophthalmol Soc

Acta Ophthalmol Scand

Retina

Trans Pa Acad Ophthalmol Otolaryngol

Pnematic retinopexy

Surgical results. Arch Ophthalmol

Pneumatic retinopexy. A multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling. The Retinal Detachment Study Group

Ophthalmology

Comparison of pneumatic retinopexy and scleral buckling in the management of primary rhegmatogenous retinal detachment. Southern Wisconsin Pneumatic Retinopexy Study Group

Am J Ophthalmol