Pneumatic retinopexy for retinal detachment

Surgery Overview

Pneumatic retinopexy is an effective surgery for certain types of retinal detachments. It uses a bubble of gas to push the retina against the wall of the eye, allowing fluid to be pumped out from beneath the retina. It is usually an outpatient procedure done with local anesthesia.

During pneumatic retinopexy, the eye doctor (ophthalmologist) injects a gas bubble into the middle of the eyeball. Your head is positioned so that the gas bubble floats to the detached area and presses lightly against the detachment. The bubble flattens the retina so that the fluid can be pumped out from beneath it. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.

The bubble remains for about a week to help flatten the retina, until a seal forms between the retina and the wall of the eye. The eye gradually absorbs the gas bubble.

A variation of this surgery uses a large bubble of silicone oil instead of a gas bubble to close and flatten the retina. A vitrectomy procedure, in which the vitreous gel is removed, is required to inject silicone oil. Because the silicone oil cannot be absorbed, a second procedure may be needed to remove the oil after the retinal detachment has healed.

What To Expect After Surgery

Recovery from pneumatic retinopexy takes about 3 weeks. The local anesthetic affects only the eye and wears off quickly.

The hardest part of the recovery is keeping the gas bubble in the right place until a seal forms around the tear in the retina.

• You must keep your head and eye in the proper position for 16 to 21 hours a day for 1 to 3 weeks after the surgery.
• You cannot lie on your back or the bubble will move to the front of the eye and press against the lens.
• Airplane travel is dangerous, because the change in altitude may cause the gas bubble to expand and increase the pressure inside the eye.

When silicone oil is used instead of gas, there may be less need to keep your head and eye in a precise position, because the oil bubble does not move as readily as a gas bubble. This may make the surgery and recovery easier for older adults, young children, and anyone who may have trouble keeping his or her head and eye in the proper position.

Why It Is Done

The location and size of a tear in the retina determines whether pneumatic retinopexy can be used. Pneumatic retinopexy can be useful when:

• A single break or tear caused the detachment.
• Multiple breaks are small and close to each other.
• The break is in the upper part of the retina.

The break must be in the upper half of the eyeball for pneumatic retinopexy to be practical. You have to be able to position your head so that the break and the bubble are at the highest point. If the break was on the bottom of the eyeball, you would have to stay upside down during your recovery, which would not be practical.

How Well It Works

A single treatment with pneumatic retinopexy reattaches the retina most of the time. With additional treatments such as vitrectomy or scleral buckling, the surgery is successful nearly all the time.

Chances for good vision after surgery are higher if the macula was still attached before surgery. If the detachment affected the macula, good vision after surgery is still possible but less likely.

Risks

The most frequent problems from pneumatic retinopexy include:

• Scarring on the retina, called proliferative vitreoretinopathy (PVR), which often causes the retina to detach again. This is the most common cause of failure in surgery for retinal detachment. PVR usually requires additional treatment, including surgery.
• Formation of new breaks and tears.
• Need for more than one surgery to reattach the retina. This is much more common with pneumatic retinopexy than with scleral buckling.
• Fluid persisting under the retina or being absorbed only very slowly.
• Small bubbles of the gas becoming trapped underneath the retina.

Although they do not occur very often, other complications include:

• The detachment spreading into the macula and affecting central vision.
• Increase in pressure inside the eye (glaucoma).
• Detachment of the choroid, the middle layer of tissue that forms the eyeball. Choroidal detachment occurs in a small number of people who have pneumatic retinopexy, and it usually heals on its own without further treatment.
• Bleeding in the vitreous gel (vitreous hemorrhage) or under the retina (subretinal hemorrhage), although both are very rare.

Complications that may occur when silicone oil along with vitrectomy is used instead of gas include:

• Increase in pressure inside the eye (glaucoma).
• A decrease in pressure inside the eye when the oil is removed.
• Development of problems in the cornea and lens (including cataracts).

What To Think About

Here are some of the factors to consider when comparing pneumatic retinopexy and scleral buckling:

• Pneumatic retinopexy is not as successful as scleral buckling in reattaching the retina. It has a lower rate of success with the first treatment than scleral buckling does.
• Pneumatic retinopexy costs less than scleral buckling and can be done on an outpatient basis.
• Pneumatic retinopexy is a newer technique, and eye doctors have not tested all its effects. Scleral buckling is the more conventional treatment.
• If pneumatic retinopexy fails, a scleral buckle can be performed with a good success rate.

The success of pneumatic retinopexy depends on keeping the gas bubble against the retina until it flattens. This will require you to hold your head and eye in the proper position for long periods of time. Do not have the procedure if a medical condition or other situation will make you unable to maintain the right position for the time required.

Pneumatic retinopexy is not a choice for many people with glaucoma because the gas bubble can increase pressure in the eye, which may make glaucoma worse.

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Author:	Jeannette Curtis	Last Updated: September 14, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Christopher J. Rudnisky, MD, FRCSC - Ophthalmology
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