Pneumatic retinopexy is another method to fix a retinal detachment and is an alternative method to a scleral buckle and/or vitrectomy.
Pneumatic retinopexy was popularized in the 1980’s and has the advantage of being performed in the office. It is not performed in the operating room as compared to a scleral buckle or vitrectomy – both of which must be performed as operations.
Every retinal detachment starts with a hole or tear in the retina. These are so called “rhegmatogenous” retinal detachments. These are the more common types of retinal detachments.
(Other retinal detachments, such as diabetic retinal detachments or proliferative vitreoretinopathy detachments, do not start with a retinal hole or tear. These “traction” type retinal detachments are not relevant to this article.)
Retinal detachments develop as fluid migrates from the vitreous to the space underneath the retina. The retinal hole or tear allows passage of the fluid. As the fluid accumulates, the retina detaches.
By injecting air or gas into the eye, the passage of fluid may be blocked. Think of the air or gas acting as a cork to seal the retinal hole or tear.
With proper head positioning, the head is held so that the gas presses against the retinal tear/hole. Eventually, the retina reattaches and the hole becomes sealed with either freezing (cryotherapy) or laser.
In-Office Procedure – This surgery is performed in the office and avoids the usual rigors of scheduling OR time, etc. This was the initial attraction to the procedure. When introduced, most retina specialists preferred using a scleral buckle to reattach the retina – requiring an operation in the OR and much more time.
No Change in Refraction – The shape of the eye remains the same, thus, the refraction should not change. In contrast, a scleral buckle causes the eye to increase in astigmatism and nearsightedness.
Not all retinal detachments can be repaired with pneumatic retinopexy. Retinal detachments with multiple tears and those with “inferior” retinal tears are less likely to be fixed by pneutmatic retinopexy.
Redetachment rates are higher compared to scleral buckle and/or vitrectomy, probably because the vitreous is left in place and vector forces are not changed, that is, the same forces to pull on the retina and cause a tear are the same.
Cataract formation is higher due to the fact that intraocular gas comes into contact with the lens.
Discomfort – May require a retrobulbar injection to numb the eye. This can be quite “uncomfortable” in the office setting as we can not offer sedation.
Time – An effective retinopexy can take hours to perform. Depending upon the amount of subretinal fluid, size of the tear and location, repositioning of the head can only be done slowly. Often times freezing the tear or laser can be cumbersome.
When I Use Pneumatic Retinopexy to Repair Retinal Detachment
I don’t often choose pneumatic retinopexy to fix a retinal detachment. It is not my first choice. I find it quicker and more effective to use a scleral buckle and/or vitrectomy to fix a retinal detachment. The redetachment rate is lower and I can do a more effective job.
The operating room is a more controlled setting, I have the aid of anesthesia and am able to address any complications or difficulties along the way.
This flexibility is just not possible in the office.