Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment in Elderly Patients

Abstract

Purpose: To assess clinical outcomes in elderly patients aged ≥ 75 years who underwent pneumatic retinopexy (PnR) for primary rhegmatogenous retinal detachment (RRD).

Design: Retrospective cohort study.

Subjects: Patients aged ≥ 75 years with primary RRD undergoing PnR.

Methods: This study evaluates clinical outcomes among eligible patients who presented from October 1, 2010, to December 31, 2022, with a minimum of 3 months' follow-up. There were no limitations with respect to the number, size, or location of retinal breaks. Exclusion criteria included significant proliferative vitreoretinopathy or previous retinal detachment repair in the index eye, inability to maintain the postoperative posturing requirements or inability to carry out adequate examination of the peripheral retina because of media opacity. Lens status did not impact the decision to offer PnR.

Main outcome measures: Pneumatic retinopexy primary anatomic reattachment rate and postoperative best corrected visual acuity (BCVA) at 3 months.

Results: Eighty patients with a mean age of 80.6 ± 4.6 years were included in this study; 35% (28/80) were phakic and 34% (27/80) presented with a fovea-on RRD. The mean number of breaks in the detached retina was 1.52 ± 1.13, and the mean number of quadrants of detached retina was 2.35 ± 0.93. The primary anatomic reattachment rate at 3 months after PnR was 78.8% (63/80), whereas the remaining 21.2% (17/80) failed PnR and underwent an operating room procedure. There was a statistically significant improvement in logarithm of the minimum angle of resolution (logMAR) BCVA from baseline to 3 months (1.29 ± 0.94 and 0.69 ± 0.67, respectively, P < 0.001). A subgroup analysis that only included patients aged > 80 years was also performed, with a total of 39 patients with a mean age of 84.4 ± 3.5 years. The primary anatomic reattachment rate with PnR in this subgroup was 74.4% (29/39), with a statistically significant improvement in BCVA from baseline to 3 months (1.4 ± 1.05 and 0.77 ± 0.70, respectively; P = 0.004).

Conclusions: Elderly patients treated with PnR for primary RRD had relatively comparable primary anatomic reattachment rates with other surgical techniques such as pars plana vitrectomy and scleral buckle. Pneumatic retinopexy is an effective, minimally invasive office-based procedure that may be desirable for some elderly patients.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Keywords: Clinical settings outcomes; Elderly; Pars plana vitrectomy; Pneumatic retinopexy; Rhegmatogenous retinal detachment.