PNEUMATIC RETINOPEXY FAILURES - CAUSE, PREVENTION, TIMING, AND MANAGEMENT

Background: Pneumatic retinopexy is a procedure for reattaching the re tina by injecting an expanding gas bubble and using either laser or cr yopexy. The procedure is controversial because there may be a lower in itial success rate, and intraocular gas may increase the risk of proli ferative vitreoretinopathy. Methods: The authors performed a retrospec tive review of 107 unpublished consecutive cases of pneumatic retinope xy together with a literature review of 25 statistical series with pri mary attention to failures. Univariate and multivariate analyses were carried out on the data set, and adjusted odds ratios for risk factors associated with failure were calculated using logistic regression. Re sults: Initially, 74 (69%) of 107 patients had successful results, and with reoperations the success rate increased to 98%. Failure of the p rocedure to achieve retinal reattachment occurred soon after the initi al procedure, with 86% of recorded failures occurring within the first month. The initial cause of failure was new or missed breaks in 14.9% , reopened initial breaks in 11.2%, and breaks never closed in 4.6%. R isk factors that showed a correlation with failure were patients being male (adjusted odds ratio = 2.65), eyes with preoperative visual acui ty worse than 20/50 (adjusted odds ratio = 1.21), eyes with four quadr ants of retina[ detachment or total detachment (adjusted odds ratio = 2.03), aphakic or pseudophakic eyes (adjusted odds ratio = 1.91), and eyes with additional pathologic findings (adjusted odds ratio = 3.14). Poor visual outcome was associated with initial visual acuity less th an 20/50 (adjusted odds ratio = 15.7) and eyes with four quadrants of retina[ detachment or total detachment (adjusted odds ratio = 5.01). C onclusions: Failures of pneumatic retinopexy occur early in the postop erative course. Factors known to be associated with failure of retinal reattachment using scleral buckling also were associated with failure in pneumatic retinopexy. A higher success rate in females was noted, suggesting that educational efforts may need to be greater in males. P oorer visual results occurred in patients with poor initial vision and in eyes with four quadrants of retinal detachment or total detachment s