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Outcomes after Failed Pneumatic Retinopexy for Retinal Detachment

      Purpose

      To provide visual and anatomic outcomes for patients with retinal detachment (RD) in whom primary pneumatic retinopexy (PR) failed.

      Design

      Retrospective, single-center, consecutive case series.

      Participants

      Eyes with RD that failed a primary PR.

      Methods

      Anatomic and functional outcomes were evaluated for patients receiving treatment for failed PR. Three secondary procedures were compared, including repeat PR, pars plana vitrectomy (PPV), and combined scleral buckle (SB) plus PPV (SB+PPV).

      Main Outcome Measures

      Anatomic reattachment and visual acuity (VA) at 1 year.

      Results

      Of a total of 423 primary PRs performed for RD, this study included 73 cases that failed. The overall single surgery anatomic success rate for the secondary procedure was 75%; the final success rate at 1 year was 100%. There was no statistically significant difference in success rates between repeat PR (63%), PPV (76%), and SB+PPV (88%). Improvement in VA was similar at 1 year between all 3 groups. Visual acuity at 1 year was similar between eyes undergoing PPV and SB+PPV (0.47 logMAR VA [Snellen equivalent, 20/59] for PPV and 0.52 logMAR VA [Snellen equivalent, 20/66] for SB+PPV; P = 0.75). Visual acuity at 1 year was better for those without macular involvement at the time of secondary procedure compared with eyes whose maculae detached (0.29 logMAR VA [Snellen equivalent, 20/39] vs. 0.73 logMAR VA [Snellen equivalent, 20/106]; P < 0.005). Fifty percent of PR failures underwent a secondary procedure within 1 week of primary PR; 80% occurred within 1 month.

      Conclusions

      Anatomic success rates for secondary PR, PPV, and SB+PPV after failed PR were lower than published success rates for their use in primary RD. This suggests that a failed primary PR selects for RDs that are inherently more difficult to reattach. There was a trend suggesting that anatomic success rates are greater with SB+PPV than PPV and, in turn, with PPV than repeat PR. However, these differences were not statistically significant and did not translate into better VA gains at 1 year for either procedure. The suitable procedure after failed PR thus depends on patient presentation, surgeon preference, and patient preference.

      Abbreviations and Acronyms:

      BCVA (best corrected visual acuity), logMAR (logarithm of the minimum angle of resolution), PPV (pars plana vitrectomy), PR (pneumatic retinopexy), PVR (proliferative vitreoretinopathy), RD (retinal detachment), SB (scleral buckle), SB+PPV (scleral buckle plus pars plana vitrectomy), VA (visual acuity)
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      References

        • Chan C.K.
        • Lin S.G.
        • Nuthi A.S.
        • Salib D.M.
        Pneumatic retinopexy for the repair of retinal detachments: a comprehensive review (1986–2007).
        Surv Ophthalmol. 2008; 53: 443-478
        • Schaal S.
        • Sherman M.P.
        • Barr C.C.
        • Kaplan H.J.
        Primary retinal detachment repair: comparison of 1-year outcomes of four surgical techniques.
        Retina. 2011; 31: 1500-1504
        • Davis M.J.
        • Mudvari S.S.
        • Shott S.
        • Rezaei K.A.
        Clinical characteristics affecting the outcome of pneumatic retinopexy.
        Arch Ophthalmol. 2011; 129: 163-166
        • Hwang J.F.
        • Chen S.N.
        • Lin C.J.
        Treatment of inferior rhegmatogenous retinal detachment by pneumatic retinopexy technique.
        Retina. 2011; 31: 257-261
        • Goldman D.R.
        • Shah C.P.
        • Heier J.S.
        Expanded criteria for pneumatic retinopexy and potential cost savings.
        Ophthalmology. 2014; 121: 318-326
        • Gilca M.
        • Duval R.
        • Goodyear E.
        • et al.
        Factors associated with outcomes of pneumatic retinopexy for rhegmatogenous retinal detachments: a retrospective review of 422 cases.
        Retina. 2014; 34: 393-399
        • Modi Y.S.
        • Epstein A.
        • Flynn Jr., H.W.
        • et al.
        Outcomes and complications of pneumatic retinopexy over a 12-year period.
        Opthalmic Surg Lasers Imaging Retina. 2014; 45: 132-137
        • Fabian I.D.
        • Kinori M.
        • Efrati M.
        • et al.
        Pneumatic retinopexy for the repair of primary rhegmatogenous retinal detachment.
        JAMA Ophthalmol. 2013; 131: 166-171
        • Mudvari S.S.
        • Ravage Z.B.
        • Rezaei K.A.
        Retinal detachment after primary pneumatic retinopexy.
        Retina. 2009; 29: 1474-1478
        • Weichel E.D.
        • Martidis A.
        • Fineman M.S.
        • et al.
        Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment.
        Ophthalmology. 2006; 113: 2033-2040
        • Stangos A.N.
        • Petropoulos I.K.
        • Brozou C.G.
        • et al.
        Pars-plana vitrectomy alone vs vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment.
        Am J Ophthalmol. 2004; 138: 952-958
        • Adelman R.A.
        • Parnes A.J.
        • Ducournau D for the European Vitreo-Retinal Society (EVRS) Retinal Detachment Study Group
        Strategy for the management of uncomplicated retinal detachments.
        Ophthalmology. 2013; 120: 1804-1808
        • Heiman H.
        • Bartz-Schmidt U.L.
        • Bornfeld N.
        • et al.
        • for the Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group
        Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study.
        Ophthalmology. 2007; 114: 2142-2154
        • Kinori M.
        • Moisseiev E.
        • Shoshany N.
        • et al.
        Comparison of pars plana vitrectomy with and without scleral buckle for the repair of primary rhegmatogenous retinal detachment.
        Am J Ophthalmol. 2011; 152: 291-297
        • Tornambe P.E.
        • Hilton G.F.
        • Brinton D.A.
        • et al.
        A Two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling.
        Ophthalmology. 1991; 98: 1115-1123

      Linked Article

      • Re: Anaya et al.: Outcomes after failed pneumatic retinopexy for retinal detachment (Ophthalmology 2016;123:1137-1142)
        OphthalmologyVol. 124Issue 3
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          I read with interest the article by Anaya et al1 on failed pneumatic retinopexy (PR) and would appreciate the authors' thoughts on the following comments and questions. First, in the Methods section, they mention that the reasons for failure of PR were a missed or new break, persistent detachment or proliferative vitreoretinopathy.1 The definition of persistent detachment is not made clear and how it is different from failed detachment surgery (all causes) is also lacking. If it implies that there was detachment that remained unchanged (in terms of configuration and causative lesion) after PR, the reasons for such would be useful to know.
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