Retinopexia neumática para el tratamiento de desprendimientos regmatógenos de retina seleccionados

Objetivo: Determinar los resultados anatómicos y funcionales en pacientes operados de desprendimiento de retina regmatógeno con técnica de retinopexia neumática. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo con pacientes operados con técnica de retinopexia neumática en el Centro Oftalmológico de Villa Clara entre junio del 2019 y abril del 2023. Resultados: La edad media de los pacientes estudiados fue de 62,1años. Los hombres fueron más afectados que las mujeres (60,6 %). El 57,6 % de los ojos tuvo agudeza visual mejor corregida de movimiento de manos al diagnóstico y el 93,9 % mácula desprendida. En el 66,7 % de las operaciones se utilizó el hexafloruro de azufre como tamponador. Se logró el éxito anatómico con una intervención en el 81,8 % (IC 95 %: 80-83,6 %) de los casos. En estos, se alcanzó el éxito funcional en el 85,2 % (IC 95 %: 83,4 -87 %). Los ojos con éxito anatómico alcanzaron como media una agudeza visual mejor corregida de 0,5 décimas (IC 95 %: 0,2-0,7) y se logró una ganancia media de 0,4 décimas (IC 95 %: 0,3-0,5). La complicación más frecuente fue la persistencia de líquido subretinal residual, el cual se presentó con más frecuencia en pacientes mayores de 60 años y desapareció como promedio a los 55,9 días sin necesidad de tratamiento. Conclusiones: La retinopexia neumática es una muy buena opción para tratar desprendimientos de retina seleccionados. En pacientes con ninguna o mínima vitreorretinopatía proliferativa, se logran buenos resultados anatómicos y funcionales.

Objective: To determine the anatomical and functional results in patients operated on for rhegmatogenous retinal detachment using the pneumatic retinopexy technique. Methods: A descriptive, longitudinal and prospective study was conducted with patients operated on using the pneumatic retinopexy technique at Centro Oftalmológico, of Villa Clara Province, Cuba, between June 2019 and April 2023. Results: The mean age of the studied patients was 62.1 years. Men were more affected than women (60.6 %). 57.6 % of the eyes had best-corrected visual acuity of hand movement at diagnosis and 93.9 % had detached macula. Sulfur hexafluoride was used as a buffer solution in 66.7 % of the operations. Anatomical success was achieved with one operation in 81.8 % (95 % CI: 80-83.6 %) of cases. In these, functional success was achieved in 85.2 % (95 % CI: 83.4-87 %). The anatomically successful eyes achieved a mean best-corrected visual acuity of 0.5 tenths (95 % CI: 0.2-0.7), apart from a mean gain of 0.4 tenths (95 % CI: 0.3-0.5). The most frequent complication was the persistence of residual subretinal fluid, which occurred more frequently in patients older than 60 years and disappeared, on average, at 55.9 days without the need for treatment. Conclusions: Pneumatic retinopexy is a very good option to treat selected retinal detachments. In patients with no or minimal proliferative vitreoretinopathy, good anatomical and functional results are achieved.

Efficiency and safety of pneumatic retinopexy for rhegmatogenous retinal detachment / 中华眼底病杂志

Objective:To investigate the efficiency and safety of pneumatic retinopexy for rhegmatogenous retinal detachment (RRD).Methods:A prospective case series study. From January 2020 to December 2021, 27 eyes of 27 RRD patients in Joint Shantou International Eye Center were included. Among them, there were 10 males and 17 females; the mean age was 36.0±11.8 years old. There was recurrent retinal detachment in 4 eyes. Best corrected visual acuity (BCVA) and optical coherence tomography were performed. According to whether the retina was successfully reattached after a single intravitreal injection, the patients were divided into a single operation group and a second operation group. All eyes underwent pneumatic retinopexy, the patients received intravitreal injection of 0.3-0.5 ml 100% C 3F 8. On the next day, laser photocoagulation was performed around the retinal breaks. The mean follow-up time was 15.0±6.0 months. Outcome measures included single operation success rate, the BCVA at the last follow up and complications. The age, gender, extent of retinal detachment, number of retinal breaks, and preoperative and postoperative BCVA of patients in the single operation group and the second operation group were compared using Mann-Whiteney test or Fisher's exact test. Results:Twenty of the 27 eyes (74.1%, 20/27) had retinal reattachment after single operation, 7 of the 27 eyes (25.9%, 7/27) had retinal reattachment after the second operation. Among the 7 eyes, retinal detachment recurrence after operation, retinal detachment recurrence after tear opening, and retinal detachment recurrence with new tears occurred in 1, 4, and 2 eyes, respectively; retinas were all reattached after scleral buckling or vitrectomy. The BCVA was stable and improved in 14 and 13 eyes, respectively. Compared with the single operation group, the retinal detachment in the second operation group was wider and the BCVA before operation was worse, the differences were statistically significant ( Z=-2.842,-2.233; P<0.05). Transient intraocular pressure elevation occurred in 5 eyes; no complications such as infectious endophthalmitis, intraocular hemorrhage and lens damage occurred. Conclusion:Pneumatic retinopexy is safe and effective in the treatment of RRD.

Inyección de gas intravítreo combinada con fotocoagulación con láser de argón para el tratamento de la maculopatía de la foseta del disco óptico sin vitrectomía / Intravitreal gas injection combined with argon laser photocoagulation for treatment of optic disc pit maculopathy without vitrectomy

RESUMEN Presentamos el caso de un paciente con foseta del disco óptico, quien presentó una disminución de la agudeza visual secundaria a desprendimiento seroso de retina. Se decidió realizar una inyección intravítrea de 0.3ml de gas C3F8 (100%), seguida de fotocoagulación con láser de argón en el borde temporal de la foseta, logrando reaplicación total de la retina, con reabsorción de todo el líquido subretiniano visible en la tomografía de coherencia optica (OCT) luego de 400 días. Además hubo una mejoría significativa en la agudeza visual.

ABSTRACT We present the case of a patient with an optic disk pit, presenting with great loss of visual acuity secondary to serous retinal detachment. The management chosen was an intravitreal injection of 0.3 mL of C3F8 (100%), followed by argon laser photocoagulation on the temporal edge of the pit, ), achieving total retinal reattachment , and reabsorption of all subretinal fluid visible at optical coherence tomography after 400 days, in addition to great improvement in visual acuity.

Características anatomo-funcionales del área macular por tomografía de coherencia óptica en pacientes operados mediante retinopexia neumática / Anatomical-functional characterization of the macular area by optical coherence tomography in patients undergoing pneumatic retinopexy

Objetivo: evaluar las características anatomo-funcionales de la mácula mediante tomografía de coherencia óptica de pacientes operados de desprendimiento de retina regmatógeno por retinopexia neumática. Métodos: se realizó un estudio longitudinal prospectivo en 37 pacientes en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" durante el período 2014-2016. Las variables estudiadas fueron: edad, ojo, sexo, tiempo de evolución, estado macular pre y posoperatorio (clínico y por tomografía óptica coherente), mejor agudeza visual corregida (pre y posoperatoria) y su mejoría, alteraciones y líneas de la microestructura macular posoperatoria. Para determinar la significación estadística se calculó la prueba de probabilidades exactas de Fisher (p menor o igual a 0,05). Resultados: la edad media de los pacientes fue 59 ± 11,77. Se observó predominio de ojo derecho (62,16 por ciento); sexo masculino (64,86 por ciento), con menos de 1 mes de evolución (83,78 por ciento). El 67,57 por ciento de los pacientes tenían desprendimiento macular preoperatorio. En consulta preoperatoria predominaron pacientes con visión menor o igual a 0,1 (37,84 por ciento), y en el posoperatorio el 54,05 por ciento presentaban > 0,6. En consulta posoperatoria, el 8,11 por ciento tenía desprendimiento macular determinado por clínica vs. 27,03 por ciento mediante tomografía de coherencia óptica (p= 0,015). De los pacientes con mejoría de visión, el 62,07 por ciento no presentaba alteraciones de microestructura macular. La alteración más frecuente fue el desprendimiento de retina subfoveal (18,92 por ciento). Se encontró significación estadística al relacionar mejoría de la visión y continuidad de línea interdigitación epitelio pigmentario de la retina-segmentos externos de fotorreceptores (p= 0,001). Conclusiones: la tomografía óptica coherente es una herramienta útil en la evaluación de pacientes operados de desprendimiento de retina-regmatógeno mediante retinopexia neumática. Es más sensible en la evaluación del área macular, ya que muestra elementos de la microestructura relacionados con la recuperación de la agudeza visual, que incluyen la presencia de alteraciones y aspectos de la reorganización de la capa de fotorreceptores(AU)

Objective: evaluate the anatomical-functional characteristics of the macula by optical coherence tomography in patients undergoing pneumatic retinopexy for rhegmatogenous retinal detachment. Methods: a prospective longitudinal study was conducted of 37 patients from "Ramón Pando Ferrer" Cuban Institute of Ophthalmology during the period 2014-2016. The variables studied were age, eye, sex, time of evolution, pre- and post-operative macular status (clinically and by optical coherence tomography), best corrected visual acuity (pre- and post-operative) and its improvement, postoperative macular microstructure lines and alterations. Statistical significance was determined by Fisher's exact test (p major/minor 0.05). Results: mean age of patients was 59 ± 11.77. A predominance was observed of the right eye (62.16 percent), male sex (64.86 percent), and < 1 month of evolution (83.78 percent). 67.57 percent of the patients had pre-operative macular detachment. In pre-operative consultation there was a predominance of patients with vision major/minor 0.1 (37.84 percent), whereas in postoperative consultation 54.05 percent had > 0.6. In postoperative consultation, 8.11 percent had macular detachment determined by clinical examination vs. 27.03 percent determined by optical coherence tomography (p= 0.015). Of the patients with visual improvement, 62.07 percent did not have any microstructural macular alteration. The most common alteration was subfoveal retinal detachment (18.92 percent). Statistical significance was found on relating visual improvement to line continuity interdigitation retinal pigment epithelium - outer segments of photoreceptors (p= 0.001). Conclusions: optical coherence tomography is a useful tool to evaluate patients undergoing pneumatic retinopexy for rhegmatogenous retinal detachment. The method is more sensitive when evaluating the macular area, for it reveals microstructural elements related to the recovery of visual acuity, including the presence of alterations and aspects of the reorganization of the photoreceptor layer(AU)

Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment

Purpose: To report the outcomes of pneumatic retinopexy (PR) performed as a primary surgical procedure for rhegmatogenous retinal detachment (RRD) or as a secondary procedure for recurrent RRD. Methods: We retrospectively analyzed case records of 54 patients (54 eyes) who underwent PR for RRD by injecting 0.3 ml of perfluoropropane (C3F8) in the vitreous cavity and cryopexy to break in the same sitting, followed by positioning. Results: A total 54 eyes of 54 patients aged between 17 and 84 years (mean - 51.3, median - 53 years) were included in the study. Except five eyes, all had breaks in the superior quadrants. The RRD ranged from 1 quadrant to 4 quadrants. Twenty-eight eyes (51.8%) were phakic and 26 (48.1%) were pseudophakic. The follow-up ranged from 6 to 144 months. In 25 eyes (46.2%), PR was the primary intervention and was successful in 15 (60%) eyes with a significant visual improvement (P = 0.023). Twenty-nine eyes (52.7%) with failed scleral buckle or failed pars plana vitrectomy underwent PR with a success rate of 65.5% and significant visual improvement (P = 0.0017). Progression of proliferative vitreoretinopathy changes (40%) was the most common cause of failure. The success rate was higher in phakic eyes, eyes with attached macula, superior breaks, superior RRD, and RRD limited to 3 quadrants or less. Conclusion: PR remains a minimally invasive procedure which can be used primarily or as a salvage procedure in failed surgery with moderately good success rate and minimal complications. One-step procedure reduces patient visits and ensures adequate treatment of the break.

¿Retinopexia neumática o implante de silicona para pacientes con desprendimiento regmatógeno de retina? / Scleral buckle versus pneumatic retinopexy for rhegmatogenous retinal detachments

Resumen INTRODUCCIÓN: l desprendimiento de retina de tipo regmatógeno es aquel causado por un desgarro o ruptura de la retina, y es causa frecuente de pérdida de visión. Dentro del manejo quirúrgico existen varias opciones, entre ellas el implante de silicona o cirugía convencional y la retinopexia neumática. A pesar de que la mayoría de los profesionales prefiere el uso de implante de silicona, la retinopexia neumática es un procedimiento más simple, de menor costo y sigue siendo considerada como alternativa en algunos casos de desprendimiento de retina regmatógeno, sin embargo hay poca evidencia que compare ambas intervenciones. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyeron seis estudios primarios, de los cuales tres corresponden a ensayos aleatorizados. Concluimos que el resultado anatómico podría ser mejor con el uso de implante de silicona en términos de re-aplicación de la retina y del riesgo de recurrencia del desprendimiento, pero la retinopexia neumática podría disminuir la incidencia de efectos adversos quirúrgicos oculares.

Abstract INTRODUCTION: Rhegmatogenous retinal detachment is caused by a tear in the retina and is a frequent cause of vision loss. Its treatment is mainly surgical and the following alternatives can be identified: scleral buckling or classic surgery, pneumatic retinopexy and vitrectomy. Between the first two options, most professionals prefer scleral buckling over pneumatic retinopexy, but the latter is a simpler, cheaper and lower-risk procedure, so it is still considered as an option for selected patients. However, there is little evidence comparing both interventions. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including six studies overall, of which three were randomized trials. We concluded the anatomic result might be better with scleral buckling in terms of retinal reattachment and risk of recurrence, but the risk of ocular adverse events might be lower with pneumatic retinopexy.

Retinal Redetachment After Pneumatic Retinopexy – The Importance of Case Selection

Pneumatic retinopexy is known as one of the treatment options for a specific type of retinal detachment. It is done in an office setting and may be the most cost-effective means of retinal reattachment surgery. Location and size of the retinal break remain as the major criteria for a successful outcome. We describe a case that fulfilled all except one major criteria for pneumatic retinopexy and underwent multiple procedures but failed. Fluctuation in the resolution of the retinal detachment such as in this particular case suggested possibility of early treatment failure.

A Result of Pneumatic Retinopexy for Pseudophakic Retinal Detachment

PURPOSE: To evaluate the clinical effectiveness of pneumatic retinopexy as a treatment method for pseudophakic retinal detachment. METHODS: A retrospective chart review was conducted of medical records of 38 patients who underwent pneumatic retinopexy using SF6 gas from January 2003 to December 2011 and who were observed during a follow-up period longer than 6 months. Primary and final success rates and final visual acuity were analyzed. Primary success was defined as retinal attachment at the last visit without additional surgery. Final success was defined as retinal reattachment at the last visit regardless of additional surgery. RESULTS: The mean patient age was 58.47 ± 17.00 years. All retinal tears were located in the upper retina (from 8 to 4 o'clock). Preoperative mean visual acuity was 1.17 ± 1.00 log MAR, and postoperative mean visual acuity was 0.42 ± 0.48 log MAR. The primary success rate was 61%, and patients with re-detached retina underwent repeat pneumatic retinopexy or other surgery such as scleral buckling or pars plana vitrectomy. At the final visit, all of the patients demonstrated successful results. CONCLUSIONS: Pneumatic retinopexy does not result in strabismus or refractive error, and the final success rate was 66% in our study. Therefore, pneumatic retinopexy can be considered as an effective management technique for some pseudophakic retinal detachment patients.

Changing Trends in Surgery for Retinal Detachment in Korea

PURPOSE: To analyze trends in rhegmatogenous retinal detachment (RRD) surgery among the members of the Korean Retina Society from 2001 to 2013. METHODS: In 2013, surveys were conducted by email and post to investigate the current practice patterns regarding RRD treatment. Questions included how surgeons would manage six cases of hypothetical RRD. Results were compared to those reported in 2001. RESULTS: A total of 133 members (60.7%) in 2013 and 46 members(79.3%) in 2001 responded to the survey. Preference for pneumatic retinopexy has decreased in uncomplicated primary RRD (p = 0.004). More respondents in 2013 selected vitrectomy as the primary procedure when mild vitreous hemorrhage (p = 0.001), myopia (p = 0.044) and history of successful scleral buckling on the fellow eye (p = 0.044) were added to the primary scenario. Vitrectomy was over twice as popular in cases of pseudophakic, macula-off RRD with posterior capsular opacity (p = 0.001). CONCLUSIONS: For RRD with myopia, pseudophakia and media opacity, surgical interventions over the last decade have drastically shifted from scleral buckling and pneumatic retinopexy to vitrectomy.

Streptococcus Gordonii Endophthalmitis after Pneumaic Retinopexy

PURPOSE: To report a case of streptoococcus gordonii endophthalmitis after pneumaic retinopexy in a patient with rhegmatogenous retinal detachment. CASE SUMMARY: A 40-year-old man presented with a right eye macula-on retinal detachment extending from 9 to 1 o'clock with one-clock-hour hole at 11 o'clock. After sterilizing with a Betadine solution, 0.6 cc 100% SF6 gas was injected into the vitreous through the pars plana at 11 o'clock. Two days after the injection, eyeball pain, cell and flare, and pupillary membrane developed. Under the diagnosis of endophthalmitis, vitreous tap and intravitreous vancomycin (1.0 mg/0.1 cc) and ceftazime (2.0 mg/0.1 cc) were administered. However the symptoms and signs worsened, so vitrectomy was performed, and intravitrous injections of silicone, vancomycin and ceftazime were administered. Streptococcus gordonii was identified from the excised vitreous. Visual acuity was light perception due to severe retinal necrosis. CONCLUSIONS: In cases of endophthalmitis after pneumatic retinopexy even with meticulous sterilization, a prompt operation is necessary to prevent extensive retinal damage and visual loss due to the possibility of pathogen growth other than conjunctival normal flora.

Management of retinal detachment in block related globe perforation with pneumatic retinopexy.

Retinal detachment after ocular perforation related to local anesthesia is a common complication, which is usually associated with a poor prognosis despite complex vitreoretinal surgical procedures. We report a case of 62-year-old male with cataract surgery done 4 weeks back with nasal retinal detachment with a posterior break. Pneumatic retinopexy was performed and laser barrage of the breaks was done the next day when the retina got attached. A vision of 20/30 was achieved at the end of 2 months. To the best of our knowledge, this is a first case report in literature where pneumatic retinopexy was used to manage a retinal detachment caused by block-related perforation.

The Success Rate and Factors Influencing the Results of Pneumatic Retinopexy

PURPOSE: To evaluate the success rate of pneumatic retinopexy and the preoperative factors influencing the results in the rhegmatogenous retinal detachment patients. METHODS: We analyzed retrospectively the preoperative and postoperative retinal findings and postoperative complication in 152 eyes of 150 patients with uncomplicated rhegmatogenous retinal detachment, who had undergone pneumatic retinopexy and were followed up for at least 3 months. We analyzed preoperative factors, including age, sex, location and numbers of retinal tears, duration of retinal detachment, lens status, and refractive error. RESULTS: The success rate of the initial surgery was 72.37%. The success rate was significantly higher in non-high myopic and phakic eyes, and when the retinal detachment was less than 3 quadrants with the retinal break located superiorly. Accordingly, the success rate was 85.87% (79 of 92 eyes). CONCLUSIONS: In the present study, the anatomical success rate of primary pneumatic retinopexy was more than 70%. If pneumatic retinopexy is performed to non-high myopic, phakic eyes, and retinal detachment is less than 3 quadrants with superior retinal break, the surgeon can expect good anatomical outcomes and consider pneumatic retinopexy as a first management in rhegmatogenous retinal detachment patients.

Pneumatic retinopexy vs subretinal drainage in scleral buckling procedure for primary rhegmatogenous retinal detachment / 第三军医大学学报

Objective To compare the efficacy of pneumatic retinopexy and subretinal drainage in the treatment of primary rhegmatogenous retinal detachment(RD) in scleral buckling procedure.Methods Pneumatic retinopexy or subretinal drainage was applied during the scleral buckling procedure when lots of subretinal fluid existed.Results Twenty-three of 26 eyes(88.5%) were successfully reattached by pneumatic retinopexy during scleral buckling procedure for the repair of primary retinal detachment.New hole formation was the major complication for the surgical failure.One eye was fixed by another buckling procedure and the other two were treated by vitrectomy.Eleven of 12 eyes(91.7%) with primary RD were successfully managed by scleral buckling procedure and subretinal fluid drainage.Subretinal hemorrhage occurred in one eye after subretinal drainage.Conclusion Pneumatic retinopexy can substitute subretinal drainage in the repair of primary rhegmatogenous retinal detachment when plenty of subretinal fluid exists.

The Factors Influencing to the Results of Pneumatic Retinopexy

PURPOSE: To evaluate the preoperative factors influencing results of pneumatic retinopexy in patients with rhegmatogenous retinal detachment. METHODS: We analyzed retrospectively the preoperative and postoperative retinal findings, visual results, postoperative complications in 98 eyes of 98 patients who had undergone pneumatic retinopexy and followed for at least 3 months. RESULTS: Postoperatively visual acuity improved in 46 out of 59 patients whose preoperative visual acuity was equal to or less than 0.08, and in 20 out of 27 patients whose preoperative visual acuity was equal to or less than 0.5. The success rate of initial surgery was 75.5% and the final reattachment rate 99.0%. The anatomic success rate of each group did not differ in terms of the duration of retinal detachment, the size or quadrantal location of retinal break. The success rate was decreased when retinal detachment was broader or retinal breaks were multiple, although the difference was not statistically significant. The success rate was significantly lower when retinal break was located posterior to the equator than when retinal break was located on or anterior to the equator (40.0% vs 80.3%, 70.4%) (p=0.02). The main causes of failure in primary retinal reattachment were as follows: reopened retinal break in 8 eyes, new retinal break in 7 eyes, delayed absorption or shift of subretinal fluid in 5 eyes, proliferative vitreoretinopathy in 2 eyes, subretinal gas in 1 eye and endophthalmitis in 1 eye. CONCLUSIONS: Our results showed that the axial location of retinal break was the only preoperative factor influencing the success rate of pneumatic retinopexy. However, other factors may not be completely ruled out as influence factors for success rate considering the small number of patients in our study. Further study including larger series will be needed.

Clinical Analysis According to Treatment Methods in Simple Retinal Detachment

PURPOSE: To determine the difference among the results of three kinds of methods for the treatment of simple retinal detachment. METHODS: We analyzed the patients undergoing primary pars plana vitrectomy(Group I: January to June, 1997), scleral buckling(Group II: January to June, 1996) and pneumatic retinopexy(Group I: January to June, 1995) to treat simple retinal detachments with retinal breaks located in peripheral retina, smaller than one clock hour, breaks in the superior eight clock hours, multiple breaks extending less than two clock hours and no severe retinal traction. RESULTS: The final visual acuity was 5/200 or more(functional success) in 19 eyes(100%) of Group I, 19 eyes(100%) of Group cII and 20 eyes(90.9%) of Group I. Primary retinal reattachment(anatomical success) was in 17 eyes(89.5%) of Group I, 19 eyes(100%) of Group II and 18 eyes(81.8%) of Group I with no statistically significant difference among the three groups. The final retinal reattachment rate was 100% in all groups. CONCLUSIONS: This result suggests the scleral buckling might be a little bit better for the treatment of simple retinal detachment, though each of three surgical methods showed no statistical difference of functional and anatomical results.

Clinical Evaluation of Pneumatic Retinopexy

Result and complications were evaluated in 28 eyes of 28 patients who had undergone pneumatic retinopexy for rhegmatogenous retinal detachment from December 1994 to May 1995 and were followed for at least 4 months. Twenty four eyes were phakic, one eye aphakic and three eyes pseudophakic. 0.3mlof perfluoropropane(4 eyes)or 0.45ml of sulfur hexafluoride(24 eyes)was injected. Mean follow-up time was 33.3 months. Perioperative complications included subconjunctival gas in 2 eyes, subretinal gas in 1 eye and delayed absorption of subretinal fluid in 5 eyes. Retinal reattachment was obtained in 22 eyes(79%) and final reattachment rate was 100% with an additional procedure of scleral buckle(4 eyes)or pars plana vitrectomy(2 eyes). Final visual acuity improved in 25 eyes(89%), and decreased in 2 eyes. Postoperatively following complications were noted;mild proliferative vitreoretinopathy(3 eyes), epiretinal membrane(1 eye), central retinal artery occlusion(1 eye), nucleosclerosis(4 eyes)and cataract operation(2 eyes). This result suggests that pneumatic retinopexy could be a good method for the treatment of rhegmatogenous retinal detachment.

Comparison of Pneumatic Retinopexy with Scleral Buckling in the Management of Rhegmatogenous Retinal Detachments

Pneumatic retinopexy(PR) is an alternative procedure to treat an uncomplicated rhegmatogenous retinal detachment with the retinal tear(s) within the superior 8 clock hours of the retina. To determine the efficacy of the PR, the authors treated 45 consecutive retinal detachment not exceeding proliferative vitreoretinopathy grade C2 with PR(PR group) and compared the results with those of 63 similar cases treated with scleral buckling procedure(SB group). Initially, 87% of PR group and 91% of SB group were reattached. However, overall cure rates with single operation decreased to 789,6 and 83%, respectively. With subsequent procedures, retinas were finally reattached in 98% and 94%, respectively. In eyes with preoperative macular detachment, vision was similarly improved 2 lines or more in 73% of PR group and in 77% of SB group after surgery. The incidence of the new breaks was higher in PR group than in SB group(9% vs 5%). Other postoperative complications including reopening of original tear, proliferative vitreoretinopathy, and delayed resorption of subretinal fluid were also noted with similar frequency in both group. These data suggest that PR would be a good alternative procedure in the selected cases of retinal detachments and initial failure with this procedure does not adversely affect the final retinal attachment.

The Effect of Pneumoretinopexy on the Retinal Detachment with a Macular Hole

Fourteen eyes of retinal detachment with macular hole were treated with pneumoretinopexy on the outpatient basis. Under the retnbu1bar anesthesia, 0.2ml of perfluoropropane(C3F8) gas was injected into the subretinal fluid was aspirated with the same needle through the macular hole under the careful control by indirect ophthalmoscopy with temporal lying position. Average amount of subretinal fluid aspirated was 0.35ml (O.35-1.00ml) and retinal elevations were reattached after pneumoretinopexy and three of four failed patients agreed to reoperation were reattached after scleral buckling or vitrectomy. Postoperative complications after pneumoretinopexy were transient elevation of intraocular pressure (2/14 eyes) and new break formation (3/14 eyes). We think the pneumoretinopexy is a good choice of primary procedure for the retinal detachment with a macular hole because it is a simple procedure with a relatively good results.

Clinical Report of Peumatic Retinopexy

Pneumatic retinopexy was introduced by Hilton in 1986, and this methed is a recently described procedure used for the treatment of primary rhegmatogenous retinal detachment. A gas bubble is injected into the vitreous cavity so that the bubble closes the retinal break, permitting resorption of subretinal fluid. A chorioretinal adhesion formed around the break by cryotherapy or laser photocoagulation secures the retina in place. Indication of pneumatic retinopexy in A Two-step Outpatient Operation Without Conjuntival Incision described by Hilton in 1986 is retinal detachments secondary to one break or group of breaks no larger than 1 o'clock hour located within the superior 8 o'clock hours of the fundus. The ocular conditions of the 26 cases included in this study were proliferative vitreoretinopathy C1, C2, aphakia, multiple breaks in multiple quadrants, extensive retinal detachment more than 3 quadrants in size, pseudophakia. The overall success rate for primary pneumatic retinopexy was 73.1%(19 eyes). The greatest number of failure were due to delayed absorption of subretinal fluid (5 eyes). With subsequent procedure, 7 eyes that failed with primary pneumatic retinopexy were reattached.

Choroidal Detachment after Pneumatic Retinopexy

Pneumatic retinopexy is a new procedure that is effective in treating the uncomplicated cases of rhegmatogenous retinal detachments. The procedure of pneumatic retinopexy is composed of cryotherapy(photocoagulation), intraocular gas injection and postoperative positioning. The advantages of this procedure are less tissue damage, no hospitalization, reduced expense and minimal complication. For these reasons, this procedure has become popular retinal detachment surgeons. Peports of associated complications are still limited. The authors experienced one case of choroidal detachment after intraocular gas(SF6 gas) injection in rhegmatogenous retinal detachment in pseudophakic eye.