Patients Prefer Pneumatic Retinopexy Over Vitrectomy as Retinal-Detachment Fix

By David Douglas

June 29, 2020

NEW YORK (Reuters Health) - Compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair, pneumatic retinopexy (PnR) may provide superior vision-related quality of life, according to a post hoc analysis of trial data.

"These findings support the results of the recent PIVOT randomized trial, which demonstrated superior visual acuity and less vertical distortion in patients undergoing pneumatic retinopexy compared to pars plana vitrectomy," said Dr. Rajeev H. Muni of St Michaels Hospital, in Toronto.

"There are several treatment options for retinal-detachment repair and traditionally the focus has been on primary anatomic reattachment rates," he told Reuters Health by email. "However, what is most important are functional outcomes and patient-reported outcomes such as the 25-Item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25)."

Dr. Muni and colleagues used the NEI-VFQ-25 and subscale scores to compare outcome at six months between 75 patients who underwent PnR and 77 who had PPV in the PIVOT trial. Several subscales showed an association of PnR with superior vision-related functioning.

After adjusting for factors including age, sex and visual acuity in the nonstudy eye, the PnR group had significantly higher scores for distance activities, mental health, dependency, and peripheral vision. The team note that several of the NEI-VFQ-25 subscale scores showed more than a 6-point between-group difference, "which is considered a clinically relevant disparity."

"To our knowledge," Dr. Muni added, "this is the first randomized controlled trial in retinal-detachment repair that compared outcomes from the patient perspective. The results clearly demonstrate an advantage for pneumatic retinopexy compared to vitrectomy in the first 6 months - likely attributed to the superior functional outcomes, reduced invasiveness and less morbidity with pneumatic retinopexy."

Senior author Dr. Roxane J. Hillier of Newcastle University, in Newcastle upon Tyne, England, told Reuters Health by email, "This data reflects a wider paradigm shift that is occurring amongst retinal surgeons. No longer does anatomical reattachment of the retina define success. It is becoming clear that the type of surgical intervention undertaken has the potential to influence the functional outcome. Therefore, to provide patients with the best possible visual outcomes, surgeons need to embrace a range of retinal-detachment-repair techniques - including pneumatic retinopexy."

In an accompanying editorial, Dr. Christina Y. Weng further notes that "We place so much emphasis on how many letters in a bright white box a patient can identify while sitting in an artificially darkened room yet fail to account for 99% of their vision-dependent daily activities, such as driving, reading, and socializing."

In an email to Reuters Health, Dr. Weng of Baylor College of Medicine-Cullen Eye Institute, in Houston, Texas, added, "While visual acuity and anatomic reattachment are important measures to evaluate following retinal-detachment repair, patient-centric visual-function outcomes are equally pertinent since they reflect how vision translates from a letter chart to real life. It is encouraging to see the growing interest in vision-related function after retina surgery, especially in the context of pneumatic retinopexy, which may be an excellent treatment option for certain patients."

SOURCE: and JAMA Ophthalmology, online June 18, 2020.