Abstract
Purpose :
Macula off retinal detachments (RDs) represent a potentially visually devastating condition. Pneumatic retinopexy (PR) offers a prompt treatment option, but lower primary anatomic success rates than other surgical options. We aim to evaluate the visual outcomes of eyes with macula off RDs that failed initial PR compared to other primary surgical approaches.
Methods :
Retrospective chart review of all patients diagnosed with a macula off RD was undertaken. Those eyes treated with PR were evaluated for anatomic success and final visual acuity (VA), amongst other data points. A comparative cohort was identified consisting of eyes treated with primary scleral buckle (SB) or scleral buckle and pars plana vitrectomy (SB/PPV) with pathology in which PR is an indicated treatment option. These cohorts were compared to the subset of eyes unsuccessfully treated with primary PR, most notably for final VA. Primary SB was also compared to secondary SB following failed PR and primary SB/PPV compared to secondary SB/PPV following failed PR.
Results :
In total, 242 eyes were diagnosed with a macula off RD with 90 eyes (37.2%) treated primarily with PR. For all eyes undergoing PR, mean final VA was 0.36±0.05 logMAR (20/45). Pneumatic retinopexy was successful in 44 eyes (48.9%) with a mean final VA of 0.15±0.02 logMAR (20/29) and 90.1% achieving 20/40 or better final VA. Those eyes that failed PR required additional intervention with 33 (71.7%) secondarily treated with SB/PPV, 9 (19.6%) with SB and 4 (8.7%) with PPV. Failed PR undergoing secondary SB/PPV achieved a mean final VA of 0.53±0.11 logMAR (20/67) compared to 28 eyes primarily treated with SB/PPV with mean final VA of 0.59±0.11 logMAR (20/78; p=0.70). Both cohorts had comparable mean VA at initial presentation, 1.89±0.17 logMAR for failed PR versus 2.06±0.14 logMAR for primary SB/PPV (p=0.46). Similarly, failed PR undergoing SB reached mean final VA of 0.45±0.14 logMAR (20/56) compared to 9 eyes treated with primary SB with 0.42±0.18 logMAR (20/53; p=0.83).
Conclusions :
When indicated, PR offers eyes with a macula off RD the potential for significant VA improvement and, even if primary PR fails, the VA results are comparable to primary PPV/SB and primary SB.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.