Expanded criteria for pneumatic retinopexy

This retrospective study found that pneumatic retinopexy is an effective treatment for primary rhegmatogenous retinal detachment, and increasing its utilization would significantly reduce medical spending while maintaining outcomes.

The study included 141 eyes that underwent pneumatic retinopexy for primary rhegmatogenous retinal detachment (RRD). The traditional group consisted of eyes deemed to be ideal candidates for pneumatic retinopexy while the nontraditional group had characteristics traditionally felt to adversely affect outcomes, including mild vitreous hemorrhage and mild proliferative vitreoretinopathy.

At six months after surgery, overall anatomic success was 78.7% and visual acuity improved significantly. The final anatomic success rate was 97.6% after further surgical intervention in 21.3% of patients. Anatomic outcomes were similar between traditional versus nontraditional, phakic versus pseudophakic and macula-on versus macula-off groups.

Visual outcomes were similar between the traditional versus nontraditional groups and phakic versus pseudophakic patients but better in macula-on detachments.

Cost analyses determined that increasing pneumatic retinopexy utilization from the current rate of 15% to the range of 20% to 35% could result in annual health care cost savings in the United States of $6 million to $30 million

The authors conclude that the advantages of pneumatic retinopexy over scleral buckle and vitrectomy include immediate access without need for an operating room, reduced morbidity from complications and quicker recovery. Since anatomic and visual outcomes are similar for retinal detachments with traditional and nontraditional preoperative criteria, factors such as pseudophakia, mild vitreous hemorrhage, lattice degeneration and/or lack of an identifiable break in a localized detachment should not be considered contraindications.

Question: What clinical features would you consider as contraindications for pneumatic retinopexy?