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Darin Goldman, Chirag Shah, Jeffrey Heier; Traditional versus Extreme Pneumatic Retinopexy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4956.
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Pneumatic retinopexy (PR) is an office-based procedure that is the second most common modality used to treat primary rhegmatogenous retinal detachments (RRDs) in the United States. Patient selection is critical to successful outcomes. Further insight into the preoperative factors that affect outcomes following PR can help guide retina surgeons in their choice for primary RRD repair. This study evaluates anatomical and functional outcomes of PR in patients with traditional and extreme preoperative criteria.
A large single-center, retrospective, consecutive case series of PR for the treatment of primary RRD was conducted over 2.5 years. All eyes with primary RRD that underwent PR were included. Preoperative characteristics, anatomic outcomes and best-available visual acuity were collected. The primary cohort was divided into two groups based on preoperative characteristics: 1) traditional PR or 2) extreme PR. The traditional group included “ideal” candidates for PR. The extreme group included eyes with non-traditional inclusion criteria such as vitreous hemorrhage, mild proliferative vitreoretinopathy, extensive lattice, inferior breaks, breaks in attached and detached retina, or no identifiable breaks (see Figure).
143 patients were included with a mean age of 60.6 (range 32-90 years). 74.1% of RRDs were macula-on and 64.3% occurred in phakic eyes. At 6 months, overall anatomical success was 76.2% and visual acuity (VA) improved significantly (LogMAR 0.48 to 0.24; Snellen equivalent 20/60 to 20/36, p<0.005). 23.8% of eyes required subsequent surgical repair with a 97.7% final anatomic success rate at 6 months. Anatomical outcomes were not different between traditional vs extreme (80% vs 73.1%, p=0.46), phakic vs pseudophakic (77.2% vs 74.5%, p=0.83), and macula-on vs -off (75.5% vs 78.4%, p=0.64) groups. Visual outcomes were similar between each the traditional vs extreme and phakic vs pseudophakic groups. For macula-off RRDs, VA improved significantly (LogMAR 1.25 to 0.41, Snellen equivalent 20/400 to 20/60, p<0.005). An inferior retinal break predicted anatomic failure (p=0.003).
Pneumatic retinopexy is an effective treatment modality for primary RRD. Anatomic and visual outcomes are similar in RRD’s with traditionally accepted inclusion criteria compared to those with more extreme criteria. Outcomes are also similar in phakic and pseudophakic eyes.
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