TREVISO, Italy — A prospective, randomized study carried out at St. Michael’s Hospital in Toronto showed superior results for pneumatic retinopexy compared with pars plana vitrectomy in patients with retinal detachment.
“David defeats Goliath,” study co-author Louis Giavedoni, MD, said at the Retina 2020: New Trends meeting.
“Contrary to current trends in the U.S., pneumatic retinopexy (PR) has continued to be our preferred method over the years, but we did not have proper evidence to support our choice ... until my younger colleague, Rajeev Muni, decided to spearhead a prospective study comparing the outcomes of PR and pars plana vitrectomy (PPV) in our hospital,” Giavedoni said.
The study, published in Ophthalmology, included 176 patients with macula-on and macula-off detachment, with a single break less than 1 clock hour wide or a group of breaks within 1 clock hour in the detached retina. Patients were recruited over a 4-year period and randomly assigned to receive either PR or PPV.
At every time point in the follow-up, visual acuity after PR was better than in the PPV group, with a difference of 10 letters at 3 months and 5 letters at 12 months. Ninety percent of patients in the PR group achieved 20/40 or better at 12 months compared with 75% in the PPV group. Anatomic success after one operation was slightly higher in the PPV group but reached 99% in both groups after more than one procedure, and in a visual function questionnaire, patients in the PR group reported better outcomes. Metamorphopsia testing showed some vertical distortion in 37.9% of patients in the PR group and 56.7% of patients in the PPV group.
“Not surprisingly, the need for cataract surgery within 1 year was 65% vs. 16% in the PPV and PR groups, respectively,” Giavedoni said. “The better visual results with significantly less distortion and significantly lower cataract rate support our choice in favor of PR and should encourage other surgeons to reconsider this method as first treatment.” – by Michela Cimberle
Giavedoni L. Functional outcomes of pneumatic retinopexy versus vitrectomy in primary retinal detachment: David against Goliath? Presented at Retina 2020: New Trends; Jan. 24-25, 2020; Treviso, Italy.
Hiller RJ, et al. Ophthalmology. 2019;doi:10.1016/j.ophtha.2018.11.014.
Disclosure: Giavedoni reports no relevant financial disclosures.