Pneumatic retinopexy: the evolution of case selection and surgical technique. A twelve-year study of 302 eyes.

BACKGROUND: Pneumatic retinopexy is an operation for reattaching the retina by injecting an expanding gas bubble and using laser and/or cryopexy. The procedure is controversial because the literature reports a variable initial success rate, sometimes less than conventional scleral buckling surgery. PR is done in an office setting and may be the most cost-effective means of retinal reattachment.

OBJECTIVE: The goal of this study is to decide which eyes are most successfully treated with pneumatic retinopexy, and which pneumatic technique is most effective.

METHODS: Three hundred two (302) consecutive retinal detachments treated by one surgeon with pneumatic retinopexy and followed for six months to ten years were reviewed. Risk factors for failure were detected. The cost of treating eyes with pneumatic retinopexy and scleral buckling was compared using Medicare reimbursement rates.

RESULTS: The average single operation success (SOS) rate for all 302 cases was 68%; 95% were ultimately attached with additional surgery. Factors adversely affecting SOS included pseudophakia/aphakia, the extent of the retinal detachment, and the number of retinal breaks. Factors not influencing SOS included the type of retinal break, the presence of lattice degeneration, the type, volume and sequence of gas injection, retinopexy with laser or cryotherapy, and gender. Complete 360 degrees peripheral retinopexy between the insertion of the vitreous base and ora serrata significantly improved SOS. A 97% SOS rate was detected for a subgroup of eyes. This subgroup included phakic eyes with one quadrant of the retina detached, and one retinal break located in the upper two-thirds of the fundus. Treatment included 360 degrees of peripheral retinopexy. Factors positively influencing visual recovery included SOS, better preoperative acuity, macular attachment, duration of macular detachment less than eight days, and younger age. Eighty-six percent of eyes cured with a single operation attained 20/40 or better acuity. The cost of repairing these 302 cases with pneumatic retinopexy, including reoperations, was estimated to be approximately half the cost of repairing a similar group with scleral buckling. With careful patient selection and peripheral 360 degrees retinopexy, the cost of PR may be one quarter the cost of scleral buckling.

CONCLUSIONS: Success with PR, as with other surgical procedures, depends upon proper case selection and surgical technique. Ideal case selection and peripheral 360 degrees retinopexy can increase the SOS rate to 97%. Even with reoperations, PR is more cost effective than scleral buckling.