Pneumatic Retinopexy for the Management of Rhegmatogenous Retinal Detachment

TL;DR

This paper compares two treatments for retinal detachment, finding that pneumatic retinopexy offers better vision and fewer cataracts than vitrectomy.

Contribution

The paper provides a comparative analysis of pneumatic retinopexy and vitrectomy outcomes, emphasizing functional vision and cataract risk.

Findings

Pneumatic retinopexy (PnR) results in better best-corrected visual acuity and less metamorphopsia than pars plana vitrectomy (PPV).

PnR is associated with lower cataract progression rates due to reduced oxygen and light toxicity and better photoreceptor preservation.

Despite lower initial reattachment rates, PnR achieves similar final reattachment rates to PPV with superior functional outcomes.

Abstract

Pneumatic retinopexy (PnR) is a minimally invasive, office-based procedure for the management of rhegmatogenous retinal detachment (RRD) in selected patients. Pars plana vitrectomy (PPV) is another common surgical approach for RRD repair, as well as for various other retinal pathologies. PnR is associated with superior functional outcomes, particularly best-corrected visual acuity (BCVA) and metamorphopsia, along with lower rates of cataract progression compared to PPV. This narrative review compares the two techniques, explaining these outcomes. We performed a literature search using PubMed, the Cochrane Library, and Google Scholar to identify articles comparing PnR to PPV. Systematic reviews, meta-analyses, and randomized controlled trials (RCTs), published in the English language within the last 10 years, were included. PnR is associated with lower rates of metamorphopsia than PPV due to reduced retinal displacement and better preservation of photoreceptor integrity. Additionally, factors such as oxygen and light toxicity, aging, lens touch, and tamponade agents contribute to more frequent cataract development following PPV than PnR. Although the primary reattachment rate of PnR is lower than that of PPV, the final reattachment rate is similar. Despite this, BCVA appears to be superior with PnR due to PPV’s stronger association with retinal displacement, outer retinal folds, and discontinuity of outer retinal layers. While PPV is a commonly performed procedure for RRD repair, PnR offers superior functional visual outcomes and a lower risk of cataract progression. Future research, particularly larger RCTs with longer follow-ups, should focus on the quality of vision rather than solely on anatomical success.