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Rodney P. Coe, Ian Gorovoy, Vera Mayercik, Thomas R. Friberg, Andrew W. Eller; Pneumatic Retinopexy Failures and The Pneumatic Pump: A New Complication. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6165.
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Pneumatic retinopexy (PR) has become a routine procedure for retinal detachment repair over the past 25 years. The success rates do not, however, approximate the results for surgical repair. In this study, we reviewed a three-year series of PR cases, specifically evaluating failures. We define a previously unreported mechanism of how some failures can occur.
135 consecutive who underwent PR between January 2007 and April 2010 for rhegmatogenous retinal detachments were included in this study. The primary outcome measure was the clinical characteristics of PR failures. Typically, 0.3-0.4 cc of SF6 were used. Secondary outcome measures included visual acuity, postoperative complications, and patient demographic data.
75% of patients had successful results with PR; 100% were ultimately reattached with additional surgery. 97% of the failures occurred within the first postoperative month and 85% occurred in the first 10 days. The mean number of gas injections for successful PR was 1.3±0.2. The most common cause of failure was a new detachment from a new break (65%). Re-opening of the initial break or failure of the initial break to close associated with persistent or increased subretinal fluid occurred 35% of the time. One case of failure of this last group occurred in a patient who performed the steamroller maneuver five times. Mean best corrected visual acuity was logMAR 0.84 preoperatively and logMAR 0.34 for the best postoperative recording. Risk factors for failure included visual acuity under 20/60 (odds ratio (OR) = 1.89), male gender (OR = 1.52), age >60 (OR = 1.32), >2 breaks (OR = 1.28), pseudophakia/aphakia (OR = 1.20) and detachments after trabeculectomy (OR = 2.43). Lattice degeneration, high myopia (>-6.00 diopters), left eye, retinal detachments after cataract surgery or YAG laser capsulotomy had minimal influence on the success of PR (all OR < 1.10).
Characterization of PR failures will improve patient selection. We have named a complication secondary to the patient performing the steamroller maneuver 5 times the "pneumatic pump", which we have not previously seen in the literature. We believe that the extension of the detachment following the injection of a second gas bubble may be due to a pumping mechanism induced by the buoyant force of the gas balanced against tractional vitreous forces on the gel.
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