The management of subretinal gas following attempted pneumatic retinal reattachment

Pneumatic retinopexy is a recently described procedure for treating retinal detachments with cryotherapy and intraocular gas injection, rather than scleral buckling. Prospective studies are underway to assess its safety and efficacy. One potential complication of this technique is persistent detachment due to subretinal gas. We report seven cases of subretinal gas following attempted pneumatic retinal reattachment. In all cases, multiple fish-egg gas bubbles were present following injection; some of these bubbles gained access to the subretinal space during the early postoperative period. The subretinal gas gave the detached retina a pearly, dome-shaped, refractive sheen. Three cases were managed by positioning the patients' heads to allow the subretinal gas to pass through the retinal break back into the vitreous cavity. One case underwent successful scleral buckling that closed the retinal break despite the presence of a small subretinal gas bubble. Three cases required vitrectomy, air-fluid exchange, and cryotherapy or endolaser treatment. In five of the seven eyes the retina was eventually reattached successfully.