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Pneumatic retinopexy may help avoid OR-based surgery
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VANCOUVER, British Columbia — Pneumatic retinopexy remains a plausible intervention for rhegmatogenous retinal detachment and may prevent the need for operating room-based surgical intervention.
 Ghassan J. Cordahi |
A retrospective analysis of 422 cases operated by two surgeons at a single tertiary referral center revealed an anatomic success rate of 65.6% after first intervention and 99.3% after any needed reoperation, Ghassan J. Cordahi, MD, FACS, said here at the American Society of Retina Specialists annual meeting. Three patients in the series had persistent retinal detachment after a maximum of five surgeries, Dr. Cordahi said.
The anatomic success rate is similar to what has been reported in the literature; however, the rate may be skewed by the intentional inclusion of potentially challenging cases, Dr. Cordahi said. The point of the analysis was to achieve a "real world" view of the success of pneumatic retinopexy, he said.
Patients with prior surgery for retinal detachment, traumatic retinal detachment, inferior breaks, inferior lattice, multiple breaks, diabetic retinopathy and previous laser or cryopexy were included in the analysis, Dr. Cordahi said.
Pseudophakic lens status and male sex were significantly associated with need for reoperation. Macula-off detachment was associated with lower final visual acuity.
"Pneumatic retinopexy is cost-effective and office-based, which makes it very useful in times of limited resources and limited access to the operating room," Dr. Cordahi said.
These results confirm the role of pneumatic retinopexy in the treatment of rhegmatogenous retinal detachments. Cordahi and colleagues, included straightforward detachments as well as more challenging detachments in this large case series. Anatomic success rate was very high and final visual status was limited by status of the macula prior to the first procedure. Two other key points regarding pneumatic retinopexy are: 1) failure is typically related to either inability to identify all breaks, or new breaks (post-procedure) can develop as a consequence of posterior vitreous separation in evolution, and 2) the exceptionally low incidence of operative complications as compared to either scleral buckling or pars plana vitrectomy. With careful follow-up and aggressive intervention at the first signs of failure, pneumatic retinopexy is a safe and effective procedure.
– Elias Reichel, MD
Boston