Retinal detachment (RD)
Pneumatic Retinopexy: A Two-step Outpatient Operation without Conjunctival Incision, 1986
n=20, 6m
Study question: First presentation of the surgical technique pneumatic retinopexy
Study results: Set the primary inclusion criteria for pneumatic retinopexy.: clear media, detachments with one or more breaks within one clock hour located within the superior eight clock hours of the fundus without PVR. .Cure rate for the single pneumatic procedure 90%. No major complications were observed.
Expanded Indications for Pneumatic Retinopexy, 1988 ⏩
n=40
Study Question: PR for cases excluded in the original indications for PR. Study results: This studt included patients with multiple breaks in multiple quadrants, large tears up to 2.5 clock hours, and RDs associated with a moderate degree of PVR. The greatest number of failures were due to inferior breaks. The overall success rate for pneumatic retinopexy was 75%. New breaks occurred in 12.5% of eyes, but all of these were successfully managed (about 50% requiring surgery).
Pneumatic retinopexy. A two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling, 1991 ⏩
N=179, 2y
Study Question: pneumatic retinopexy VS scleral buckling for the management of selected retinal detachments. Study Results: re-detachment rate on both groups 1%, overall attachment 98% for PR and 99% for SB. Cataract surgery needed in 18% of the SB group VS 4% for PR. Significantly better VA for eyes with macular detachment shorter than 14 days in the PR group (89%) vs 67% for SB. Re-operation after failed PR did not affect VA. PVR rates similar in both groups (5% SB, 3% PR). Criticism: Valone noted that in simple RD the single-operation success for the SBP was only 82%, suggesting variations in outcome among participating surgeons. SBP eyes had a longer duration of macular detachment than PR. Lincoff suggested SB final VA was worse d/t potentiall effects of encircling buckles, SRF drainage, and air or gas injection in the SBP.
Vitrectomy with silicone oil or sulfur hexafluoride gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial. Silicone Study Report 1 (Silicone Oil Study, SOS), 1992 ⏩, second report ⏩, and others ⏩
n= 352, 3y
Study question: PPV for Severe PVR: Silicone oil (1000 centistokes) VS SF6. And silicone oil VS C3F8. Study results: Coined the new PVR classification. Silicone comperable to C3F8 but superior to SF6. Silicone superior to C3F8 in anterior PVR. Visual acuity better than or equal to 5/200 compared 5%-60% vs with 30% to 40% of SF6 group. Macula attachment was 80% vs 60% for SF6. Hypotony and keratopathy was more prevalent in eyes with a detached macula.
Look at a Cochrane review (2014) looking into this issue: no significant differences between silicone and C3F8 gas in terms of the proportion of participants achieving at least 5/200 visual acuity or achieving macular attachment. In contrast to the study above, there were no significant differences between SO and SF6 gas in terms of achieving at least 5/200 visual acuity at two years. Silicone oil had significantly favorable outcomes at 1 and 2 years in macular attachment. No significant differences between standard silicone oil and heavy silicone oil in VA.
Outcomes of vitrectomy with inferior retinectomy in patients with recurrent rhegmatogenous retinal detachments and proliferative vitreoretinopathy, 2006 ⏩
n=56, 25m
Study question: vitrectomy and inferior retinectomy for recurrent, RRD with PVR
Study results: Complete retinal reattachment was achieved in 93%. Radical anterior vitreous base dissection and lensectomy had a higher success rate 74% versVS 38%.Silicone oil had a higher success rate than tamponade with gas: 71% VS 18%. Silicone oil removal had a 4% redetachment rate.
Pneumatic retinopexy: the evolution of case selection and surgical technique. A twelve-year study of 302 eyes. ⏩
n=302, 6m-10y
Study question: case series of PR. Study results: This article based the notion that lattice degeneration extending 3 hours or less is not a contraindication for PR. Success rate for lattice cases was higher when 360 laser retinopexy was added (85% vs 67%, P was not significant 0.009).
Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment: A Prospective Randomized Multicenter Clinical Study (SPR), 2007 ⏩
n= 416 phakic and 265 pseudophakic, 1y
Study question: Scleral buckle VS primary Vitrectomy in Rhegmatogenous Retinal Detachment
Study results: Phakic patients: mean BCVA change was significantly greater in the SB group (−0.71 logMAR vs −0.56 in PPV. In the pseudophakic trial nonsignificant difference. Cataract progression was greater in the PPV group. Primary anatomical success rate was 53.4% vs 72.0% for PPV with less secondary surgeries in the PPV group. Re-detachment rates were similar in the phakic group 26.3% in the SB vs 25.1% in the PPV. While in the pseudophakic group higher re-detachment in the SB group (39.8%) vs 20.4% in the PPV group.
Antiplatelet and anticoagulation therapy in vitreoretinal surgery, 2011 ⏩
n=487, POD1
Study question: rates of post-operative hemorrhage after PPV in patients with antiplatelets or anticoagulants treatment VS 3 or more days suspension of tx. Study results: Incidence of bleeding was higher (20.0%) in the patients who did not suspend antiplatelets than in those who did (9.6%) but this difference lost statistical significance in a multivariate analysis. Anticoagulant was associated with higher rates of intraocular hemorrhage at POD1. No reoperation or failure of the surgery was attributable to the hemorrhage.
Pneumatic Retinopexy for the Repair of Primary Rhegmatogenous Retinal Detachment
A 10-Year Retrospective Analysis, 2013 ⏩
n=276, n-2m+
Study Question: outcome and risk factors for failure of pneumatic retinopexy treating primary rhegmatogenous retinal detachment Study Results: Successful reattachment at 2 months was achieved in 66%. Only one additional procedure for failed eyes was needed in 77.0% of the failed cases thus reaching anatomic success in 99% after 1 or 2 procedures. 1 procedure successful cases had significantly better final vision and fewer postoperative complications. Nonsignificant differences were found between the primary failure PR cases that underwent only 1 additional operation and the successful cases.
Surgical Management of Rhegmatogenous Retinal Detachment: A Meta-Analysis of Randomized Controlled Trials, 2013 ⏩
n=PPV (636 eyes), SB (670 eyes)
Study question: PPV vs SB for primary uncomplicated RRD.
Study results: no significant differences in the proportion of primary reattachments. Significant difference in the VA at 6 months between the PPV-treated and SB-treated phakic eyes due to cataract formation. A significant difference in the proportion of secondary reattachments between the PPV and SB groups in pseudophakic/aphakic eyes.
Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2 (EVRS), 2013 ⏩
n=7678
Study question: Primary surgery (PPV, Buckle, combined) for complex retinal detachments: grade B PVR, grade C-1 PVR, choroidal detachment or significant hypotony, giant retinal tears, macular holes. Study results: Grade B PVR, Choroidal detachment, hypotony or GRT treated with PPV had a lower failure rate with PPV VS buckle alone. In grade C-1 PVR, there was no difference. PPV with a supplemental buckle had an increased failure rate compared PPV alone. No difference between gas VS silicone oil in patients with grade B or C-1 PVR.
The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT), 2017 and 2019
n=176, 12mo
Study question: pneumatic retinopexy (PR) versus pars plana vitrectomy (PPV) for the management of primary RRD Study results: VA after PR exceeded that after PPV by 4.9 letters (79.9±10.4 letters vs. 75.0±15.2 Primary anatomic success 80.8% of PR versus 93.2% in PPV
Additional resources:
See this excellent practical thorough review of PR by Chan et al. from 2008.
Abbreviations used on this page:
BCVA - Best corrected visual acuity
PPV - Pars plana vitrectomy
SB - Scleral buckle
SO - Silicone Oil
POD - post operative day
PR - pneumatic retinopexy
PPV - Pars plana vitrectomy
PVR - proliferative vitreoretinopathy
VA - Visual acuity
y - year
--------------
🚧 This page is under construction.
☏ If you found a mistake or would like to relay your thoughts, please contact us using the form at the bottom of the page.
n=20, 6m
Study question: First presentation of the surgical technique pneumatic retinopexy
Study results: Set the primary inclusion criteria for pneumatic retinopexy.: clear media, detachments with one or more breaks within one clock hour located within the superior eight clock hours of the fundus without PVR. .Cure rate for the single pneumatic procedure 90%. No major complications were observed.
Expanded Indications for Pneumatic Retinopexy, 1988 ⏩
n=40
Study Question: PR for cases excluded in the original indications for PR. Study results: This studt included patients with multiple breaks in multiple quadrants, large tears up to 2.5 clock hours, and RDs associated with a moderate degree of PVR. The greatest number of failures were due to inferior breaks. The overall success rate for pneumatic retinopexy was 75%. New breaks occurred in 12.5% of eyes, but all of these were successfully managed (about 50% requiring surgery).
Pneumatic retinopexy. A two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling, 1991 ⏩
N=179, 2y
Study Question: pneumatic retinopexy VS scleral buckling for the management of selected retinal detachments. Study Results: re-detachment rate on both groups 1%, overall attachment 98% for PR and 99% for SB. Cataract surgery needed in 18% of the SB group VS 4% for PR. Significantly better VA for eyes with macular detachment shorter than 14 days in the PR group (89%) vs 67% for SB. Re-operation after failed PR did not affect VA. PVR rates similar in both groups (5% SB, 3% PR). Criticism: Valone noted that in simple RD the single-operation success for the SBP was only 82%, suggesting variations in outcome among participating surgeons. SBP eyes had a longer duration of macular detachment than PR. Lincoff suggested SB final VA was worse d/t potentiall effects of encircling buckles, SRF drainage, and air or gas injection in the SBP.
Vitrectomy with silicone oil or sulfur hexafluoride gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial. Silicone Study Report 1 (Silicone Oil Study, SOS), 1992 ⏩, second report ⏩, and others ⏩
n= 352, 3y
Study question: PPV for Severe PVR: Silicone oil (1000 centistokes) VS SF6. And silicone oil VS C3F8. Study results: Coined the new PVR classification. Silicone comperable to C3F8 but superior to SF6. Silicone superior to C3F8 in anterior PVR. Visual acuity better than or equal to 5/200 compared 5%-60% vs with 30% to 40% of SF6 group. Macula attachment was 80% vs 60% for SF6. Hypotony and keratopathy was more prevalent in eyes with a detached macula.
Look at a Cochrane review (2014) looking into this issue: no significant differences between silicone and C3F8 gas in terms of the proportion of participants achieving at least 5/200 visual acuity or achieving macular attachment. In contrast to the study above, there were no significant differences between SO and SF6 gas in terms of achieving at least 5/200 visual acuity at two years. Silicone oil had significantly favorable outcomes at 1 and 2 years in macular attachment. No significant differences between standard silicone oil and heavy silicone oil in VA.
Outcomes of vitrectomy with inferior retinectomy in patients with recurrent rhegmatogenous retinal detachments and proliferative vitreoretinopathy, 2006 ⏩
n=56, 25m
Study question: vitrectomy and inferior retinectomy for recurrent, RRD with PVR
Study results: Complete retinal reattachment was achieved in 93%. Radical anterior vitreous base dissection and lensectomy had a higher success rate 74% versVS 38%.Silicone oil had a higher success rate than tamponade with gas: 71% VS 18%. Silicone oil removal had a 4% redetachment rate.
Pneumatic retinopexy: the evolution of case selection and surgical technique. A twelve-year study of 302 eyes. ⏩
n=302, 6m-10y
Study question: case series of PR. Study results: This article based the notion that lattice degeneration extending 3 hours or less is not a contraindication for PR. Success rate for lattice cases was higher when 360 laser retinopexy was added (85% vs 67%, P was not significant 0.009).
Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment: A Prospective Randomized Multicenter Clinical Study (SPR), 2007 ⏩
n= 416 phakic and 265 pseudophakic, 1y
Study question: Scleral buckle VS primary Vitrectomy in Rhegmatogenous Retinal Detachment
Study results: Phakic patients: mean BCVA change was significantly greater in the SB group (−0.71 logMAR vs −0.56 in PPV. In the pseudophakic trial nonsignificant difference. Cataract progression was greater in the PPV group. Primary anatomical success rate was 53.4% vs 72.0% for PPV with less secondary surgeries in the PPV group. Re-detachment rates were similar in the phakic group 26.3% in the SB vs 25.1% in the PPV. While in the pseudophakic group higher re-detachment in the SB group (39.8%) vs 20.4% in the PPV group.
Antiplatelet and anticoagulation therapy in vitreoretinal surgery, 2011 ⏩
n=487, POD1
Study question: rates of post-operative hemorrhage after PPV in patients with antiplatelets or anticoagulants treatment VS 3 or more days suspension of tx. Study results: Incidence of bleeding was higher (20.0%) in the patients who did not suspend antiplatelets than in those who did (9.6%) but this difference lost statistical significance in a multivariate analysis. Anticoagulant was associated with higher rates of intraocular hemorrhage at POD1. No reoperation or failure of the surgery was attributable to the hemorrhage.
Pneumatic Retinopexy for the Repair of Primary Rhegmatogenous Retinal Detachment
A 10-Year Retrospective Analysis, 2013 ⏩
n=276, n-2m+
Study Question: outcome and risk factors for failure of pneumatic retinopexy treating primary rhegmatogenous retinal detachment Study Results: Successful reattachment at 2 months was achieved in 66%. Only one additional procedure for failed eyes was needed in 77.0% of the failed cases thus reaching anatomic success in 99% after 1 or 2 procedures. 1 procedure successful cases had significantly better final vision and fewer postoperative complications. Nonsignificant differences were found between the primary failure PR cases that underwent only 1 additional operation and the successful cases.
Surgical Management of Rhegmatogenous Retinal Detachment: A Meta-Analysis of Randomized Controlled Trials, 2013 ⏩
n=PPV (636 eyes), SB (670 eyes)
Study question: PPV vs SB for primary uncomplicated RRD.
Study results: no significant differences in the proportion of primary reattachments. Significant difference in the VA at 6 months between the PPV-treated and SB-treated phakic eyes due to cataract formation. A significant difference in the proportion of secondary reattachments between the PPV and SB groups in pseudophakic/aphakic eyes.
Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2 (EVRS), 2013 ⏩
n=7678
Study question: Primary surgery (PPV, Buckle, combined) for complex retinal detachments: grade B PVR, grade C-1 PVR, choroidal detachment or significant hypotony, giant retinal tears, macular holes. Study results: Grade B PVR, Choroidal detachment, hypotony or GRT treated with PPV had a lower failure rate with PPV VS buckle alone. In grade C-1 PVR, there was no difference. PPV with a supplemental buckle had an increased failure rate compared PPV alone. No difference between gas VS silicone oil in patients with grade B or C-1 PVR.
The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT), 2017 and 2019
n=176, 12mo
Study question: pneumatic retinopexy (PR) versus pars plana vitrectomy (PPV) for the management of primary RRD Study results: VA after PR exceeded that after PPV by 4.9 letters (79.9±10.4 letters vs. 75.0±15.2 Primary anatomic success 80.8% of PR versus 93.2% in PPV
Additional resources:
See this excellent practical thorough review of PR by Chan et al. from 2008.
Abbreviations used on this page:
BCVA - Best corrected visual acuity
PPV - Pars plana vitrectomy
SB - Scleral buckle
SO - Silicone Oil
POD - post operative day
PR - pneumatic retinopexy
PPV - Pars plana vitrectomy
PVR - proliferative vitreoretinopathy
VA - Visual acuity
y - year
--------------
🚧 This page is under construction.
☏ If you found a mistake or would like to relay your thoughts, please contact us using the form at the bottom of the page.
Comments
Post a Comment