Pneumatic Retinopexy Versus Pars Plana Vitrectomy for the Management of Retinal Detachment: A Systematic Review and Meta-Analysis

Abstract

Introduction: Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair. Methods: We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1. Results: PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2. 25-5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = -0.58, 95% CI = -1.16 to 0.00) and post-op (SMD = -0.45, 95% CI =

Efficacy of pneumatic retinopexy in young adults with rhegmatogenous retinal detachment

“…[12][13][14] In studies conducted since 2015, the success rate of PR is higher than in previous studies (82% vs 59%). 15 The reasons for such variation have yet to be determined. However, the success rate of our study is lower than the studies conducted in recent years.…”

“…Relatively high rates of retinal displacement following PPV in comparison to PR have been reported. 15 , 20 – 22 Muni et al 22 considered photoreceptor integrity between PR and PPV at 12 months postoperative on spectral-domain-optical coherence tomography (SD-OCT) in a subset of patients of the PIVOT study. In 3 mm (foveal) and 6 mm (foveal and nonfoveal) scans, the ellipsoid zone discontinuity and external limiting membrane discontinuity were found to be significantly higher in patients who underwent PPV compared to PR patients.…”

Efficacy of Pneumatic Retinopexy Preceding Pars Plana Vitrectomy in Managing Combined Retinal and Choroidal Detachment: A Retrospective Study of 64 Patients

“…Moreover, when compared with patients undergoing PPV alone, there was no significant difference in long-term retinal re-attachment rate or degree of BCVA improvement. Compared with the traditional corticosteroid hormone method, PR has the greatest advantage of shortening the time for patients with RRD-CD to receive PPV, and this method has no harsh requirements for patients’ systemic conditions [ 12 ].…”

“…Moreover, when the retinal hole is larger, the contact arc width of the bubble cannot fill the entire hole. Despite these limitations, failed pneumatic retinopexy has not been shown to affect PPV outcomes [ 12 , 17 , 18 ].…”

“…In recent years, there has been an increasing number of studies on surgical methods of PR, which are currently used in patients with RRD. Previous literature has reported that PR is proposed as an alternative to PPV in certain circumstances [ 12 ]. Relatively few studies have been conducted on PR efficacy in RD-CD cases.…”