Pneumatic retinopexy in the treatment of primary rhegmatogenous retinal detachment

To review the management by pneumatic retinopexy of 31 primary rhegmatogenous retinal detachments performed between August 1994 and December 1997.

Ocular indications included superior retinal breaks, no evidence of proliferative vitreoretinopathy (PVR) and ability to posture. Patients with inferior breaks and/or areas of vitreoretinal degeneration were excluded. Surgery was performed under local anaesthetic using sulphur hexafluoride (SF6) or perfluoropropane (C3F8) gas injection. Transconjunctival cryotherapy or laser retinopexy was used to create permanent retinal adhesion. The mean length of patient follow-up was 11 months (range 5-24 months).

Thirty-one patients (20 men, 11 women) with a mean age of 63.4 years (range 29-81 years) underwent pneumatic retinopexy which resulted in initial retinal reattachment in 22 patients. Two detachments recurred in the first month and a third at 4 months post-operatively, giving an anatomical reattachment rate with one procedure in 19 out of 31 eyes (61%). Of the 12 failures, 7 were reattached with one additional operation and one case reattached after multiple procedures, giving an overall reattachment rate of 87%. Post-operatively, new or missed breaks were present in 7 patients (22%) and PVR developed in 4 patients (13%). There was no difference in age, gender or extent of detachment between the failed and reattached groups and pseudophakia did not appear to be a poor prognostic factor.

Pneumatic retinopexy can be a useful alternative to conventional rhegmatogenous retinal detachment surgery in carefully selected cases. A larger study addressing the influence of non-ocular factors is warranted.