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Yasha Modi, Justin Towsend, Aliza Epstein, William Smiddy, Harry W Flynn; Pneumatic retinopexy for retinal detachment occurring after prior scleral buckle or pars plana vitrectomy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1098.
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To report outcomes of pneumatic retinopexy (PR) for retinal detachment (RD) occurring after prior scleral buckling surgery (SB) or pars plana vitrectomy (PPV).
Non-comparative, consecutive, interventional case series evaluating all patients treated between January 2000 and March 2013. Patients with less than one month follow-up or coexisting uveitis, endophthalmitis, neovascular age-related macular degeneration, or grade C proliferative vitreoretinopathy were excluded.
A total of 17 eyes of 17 patients were included in this study. 10 eyes underwent PR after prior SB and 7 eyes underwent PR after prior PPV. Mean age was 60.4 (range: 38 - 81) with a mean follow-up time of 33.8 months (range: 1.2 to 81 months). Of the 10 eyes undergoing PR after primary SB, 9/10 eyes had persistent subretinal fluid posterior to the buckle in the setting of an open break on the scleral buckle. The mean time to PR in these cases was 8.5 days after SB. PR alone was successful in achieving anatomic reattachment in 8/10 eyes but 2/10 eyes required additional PPV to achieve retinal reattachment. At last follow-up, the retina was attached in 10/10 eyes. Median BCVA was 20/20 (range: 20/20-20/25) in eyes with baseline macula-on detachments with and 20/40 (range: 20/25-20/70) in eyes with baseline macula-off detachments (p=0.01). Seven eyes underwent PR after prior PPV. Indications for the initial PPV included: 2 patients with retained lens fragments after complicated cataract surgery, 2 patients with macular hole surgeries, 1 patient with a prior retinal detachment managed by PPV alone, one patient with an epiretinal membrane peel after prior retinal detachment managed by SB, and one patient undergoing PPV for a subluxed crystalline lens in the setting of Marfan Syndrome. The average time to RD after PPV was 67 days (range: 15 - 232 days). The location of the break was superior in 4 eyes, horizontal in 2, and inferior in 1. Anatomic reattachment with PR alone occurred in 4/7 (57%) eyes. At final follow-up after additional treatments, the retina was reattached in 7/7 eyes and median BCVA was 20/40 (range: 20/20 to 20/80)
In the setting of recurrent RD after initial SB, pneumatic retinopexy was usually successful in the early postoperative course. In the setting of a new-onset RD after PPV, pneumatic retinopexy was a useful option but recurrent RD was more common.
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