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Jennifer Ling, Farhad Safi, Andrew Eller; Pneumatic retinopexy for pseudophakic rhegmatogenous retinal detachment. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1076.
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Pneumatic retinopexy (PR) is less successful in repairing retinal detachment (RD) in the pseudophakic eye (41-67%) compared to the phakic eye (71-84%). Our aim was to identify what pre-operative characteristics predicted PR outcome in this sub-population.
Retrospective chart review was performed with patients identified by Current Procedural Terminology (CPT) code for PR between 7/1/2010 and 4/30/2013 at a single institution. Inclusion criteria were RD in a pseudophakic eye. Exclusion criteria were prior RD, scleral buckle (SB), pars plana vitrectomy (PPV), and prior prophylactic laser or cryotherapy. Pre-operative data included demographics, integrity of the posterior capsule, presenting visual acuity (VA), duration of RD symptoms, macular status, the number, location, and extent of RD in clock hours, presence of posterior vitreous detachment (PVD), and presence of lattice degeneration. Post-operative data included follow-up procedures (SB, PPV, or combination), and 6-month post-operative retinal status and VA.
Forty-seven patients met study criteria. Single PR was successful in twenty-three (48.9%) patients. The remaining twenty-four (51.1%) patients required further SB, PPV, or combination. Of pre-operative characteristics analyzed, a retinal tear located outside of the superior 4 clock hours was a significant predictor of PR failure (odds ratio 18, P=0.009). The VA and anatomic reattachment rates at 6 months post-intervention did not differ among groups.
Prior to this study, the pre-operative factors that predict PR outcome have been investigated in a population of overwhelmingly phakic eyes. This has led to the recommendation that PR be performed when all retinal tears are restricted to the superior 8 clock hours. To our knowledge, no study has examined whether these risk factors differ in the pseudophakic population. In our study, the presence of a retinal tear located outside the superior 4 clock hours was a significant predictor of PR failure. Delineating the location to 8 clock hours did not reach statistical significance. We therefore conclude that narrowing PR criteria in pseudophakic patients may lead to higher single-procedure success rates. However, if further SB or PPV is needed, the final visual acuity and anatomic reattachment are not disadvantaged by the initial PR.
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