Abstract
Purpose: :
To determine the visual and anatomical outcomes of pneumatic retinopexy as a treatment for primary rhegmatogenous retinal detachment.
Methods: :
A retrospective study of 119 patients was conducted examining the visual and anatomical outcomes of the treatment of primary rhegmatogenous retinal detachment with pneumatic retinopexy by the vitreoretinal service at St. Michael’s Hospital. Patients were included that had completed at least 3 months of follow up. Visual acuity, detachment status, number and location of retinal breaks, lens status, and number and extent of laser treatments were compared at baseline, during, and at the end of the follow up period. Reasons for treatment failure were also examined.
Results: :
Mean follow-up was 14.8 months (3.0 to 41.3 months). Mean baseline visual acuity was 20/260 (20/20 to HM) and mean final visual acuity was 20/70 (20/20 to LP). Of the 119 patients, 77 (64.7%) remained attached for a mean follow-up of 13.52 months. Of these patients, mean baseline visual acuity was 20/240 and mean final visual acuity was 20/50 (p<0.001). Forty two patients re-detached after primary pneumatic retinopexy and subsequently underwent either secondary pneumatic retinopexy (9 patients) or surgical intervention (33 patients). In this group, mean baseline visual acuity was 20/320 and mean final visual acuity was 20/130 (p<= 0.04). Of those that underwent secondary pneumatic retinopexy, 5 patients remained attached for a mean follow-up of 13.7 months and 4 patients required subsequent surgery. Of those that failed primary pneumatic retinopexy, 27 were due to the discovery of new/missed retinal breaks, 6 due to persistent subretinal fluid, 5 due to insufficient gas, 1 due to inadequate laser retinopexy, and 3 due to proliferative vitreoretinopathy. In patients with a single retinal break, anatomic success after pneumatic retinopexy was achieved in 66.0%. In patients with multiple retinal breaks, this success was achieved in 65.0%. In patients with single superior retinal breaks (10:00 to 2:00), anatomic success after pneumatic retinopexy was achieved in 67.0%. In patients with single breaks elsewhere, this success was achieved in 62.5%.
Conclusions: :
Primary pneumatic retinopexy is an effective surgical technique for the treatment of primary rhegmatogenous retinal detachment. Of those patients that failed this therapy, a majority of cases were secondary to the discovery of retinal breaks not seen previously. There was very little difference in success concerning the number and location of retinal breaks.
Keywords: retinal detachment • vitreoretinal surgery • retina