Pneumoretinopexy versus scleral buckling in retinal detachments with superior breaks

Abstract

Purpose: The purpose of this study is to study single surgery reattachment rate, refractive shift, surgical time, cost, and complications of pneumoretinopexy (PR) compared to scleral buckling (SB) in rhegmatogenous retinal detachments (RRDs) with superior breaks. Methods: Data of RRD with superior breaks, from 2013 through 2016, treated either with PR or SB surgery at a tertiary eye-care center were retrospectively reviewed. Treatment outcomes, procedural costs, refractive shift, surgical time, and complications, namely, cataract and glaucoma, were analyzed. Results: Thirty-two cases treated by PR ( n = 15) and SB surgery ( n = 17) fulfilled the selection criteria. Macula off RRD (91%) was the commonest presentation. Baseline parameters like duration of vision loss, presenting vision, and ocular characteristics were comparable. Single surgery retinal reattachment (66.7% PR vs. 76.5% SB) was analogous ( P = 0.698). Retinal reattachment with secondary intervention was achieved in all cases at the last follow-up. Average vision gain in logMAR of 0.8 in PR and 0.6 in SB was not significantly different ( P = 0.645) between the two groups, with SB group having a 1.9 Dioptre myopic shift and PR group none. Surgical time was shorter in PR versus SB at 15 versus 85 min and surgical cost (including additional surgery) was 50% less in PR. Complications like cataract progression ( P > 0.99) and glaucoma ( P = 0.71) were analogous among the groups. Horse-shoe tears were associated with failed primary surgery in 60% of PR and 75% of SB procedures. Conclusion: In RRDs secondary to superior breaks, PR proved to be faster, more economical, and less tissue manipulative than scleral buckle surgery, with equivalent efficacy and safety profile.

Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review

“…Our review included only a small number of studies using pneumatic retinopexy for surgical management. Despite being a cost-effective and simple technique compared with PPV and scleral buckling, the infrequent use of pneumatic retinopexy as a surgical management option for GRT-associated RRDs raises questions regarding its viability in this patient population [ 77 ]. However, a high PAS rate of 90% can be achieved if appropriate patient selection is performed [ 78 ].…”

Pneumatic Retinopexy: An Experience of 12 Years at a Tertiary Care Hospital

“…This in turn leads to the slow reabsorption of SRF. It is believed that the slow reabsorption of SRF permits a slow settling of the outer part of the retina, which renders effective photoreceptor readjustment against the retinal pigment epithelium layer leading to an improved visual outcome and hence the rescue of visual impairment [ 20 ].…”

Outcome of Different Surgical Repair Techniques for Rhegmatogenous Retinal Detachment—A Health Economic Analysis in the Split-Dalmatia County, Croatia

“…The cost calculation was based upon existing DRG costs for PPV and the estimated per-minute costs for such a procedure, which were multiplied by the time associated with each procedure. Procedure durations were obtained from the literature [ 5 , 16 , 24 ]. For PHACO+PPV, the weighted costs were added to estimate the probable DRG cost assuming payment of the full costs for the PHACO part in PHACO+PPV.…”

“…PR is the surgical method that has most recently been introduced and has several advantages over other surgical techniques for RRD. It is less invasive, associated with fewer complications, performed exclusively under local anesthesia and significantly more cost-effective than the other two methods [ 5 , 6 ]. However, PR is not a suitable choice for all cases of RRD.…”