Pneumatic Retinopexy or Vitrectomy for Primary RRD
Ophthalmology, April 2019
There are many clinical circumstances under which the best technique to repair rhegmatogenous retinal detachment (RRD) is not clear. Hillier et al. compared pneumatic retinopexy (PnR) and pars plana vitrectomy (PPV) for primary RRD considered amenable to both PnR and PPV. They found that PnR produced superior visual acuity (VA) and less vertical metamorphopsia.
In this prospective study, 176 patients with RRD and one or more breaks in the detached retina within 1 clock-hour above the 8- and 4-o’clock meridians were assigned randomly to receive PnR or PPV within 24 hours (macula on) or 72 hours (macula off) of detection. The primary outcome was VA at 12 months according to the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. Other outcomes of interest were subjective visual function (25-item National Eye Institute Visual Function Questionnaire [NEI VFQ-25]), metamorphopsia score, and primary anatomic success.
Twelve-month assessments showed that mean ETDRS VA was better after PnR (79.9 ± 10.4 letters vs. 75.0 ± 15.2 letters after PPV; p = .024). Composite NEI VFQ-25 scores were better for PnR at three and six months, but similar at 12 months. At 12 months, vertical metamorphopsia scores were better for the PnR group (0.14 ± 0.29 vs. 0.28 ± 0.42; p = .026). Primary anatomic success was achieved by 12 months in 80.8% of patients who underwent PnR and in 93.2% of those who had PPV (p = .045). Secondary anatomic success was attained for 98.7% and 98.6%, respectively. Among phakic patients, 65% of those in the PPV arm and 16% of those in the PnR group underwent cataract surgery before month 12 (p < .001).
The authors concluded that PnR should be the first-line treatment for RRD in patients who fulfill the recruitment criteria of the PIVOT study. Despite the current global popularity of PPV, the relative simplicity and elegance of PnR remain attractive, said the authors.
The original article can be found here.