Outcomes of modified pneumatic retinopexy with transscleral subretinal fluid drainage for primary rhegmatogenous retinal detachment

BACKGROUND: Primary rhegmatogenous retinal detachment (RRD) occurs when a retinal tear or break causes fluid from inside the eye to seep behind the retina, which pushes it away from the wall of the eye. This can cause permanent vision loss if not treated. Which of three current interventions is optimal to treat RRD has not been established. We evaluated the anatomical and visual outcomes of a modified pneumatic retinopexy (mPnR) that drains fluid from beneath the retina to treat RRD. METHODS: This retrospective single-center case series included 53 consecutive eyes of 53 patients with primary RRD who met the pneumatic retinopexy versus vitrectomy trial criteria. All patients underwent mPnR that comprised transscleral subretinal fluid drainage, intravitreal air injection, and postoperative laser photocoagulation of retinal breaks. The main outcome measures were single-surgery anatomical success rates and best-corrected visual acuity (BCVA) at 3 months postoperatively. RESULTS: The single-surgery anatomical success rate was 51 of 53 (96.23%). Three months postoperatively, the median BCVA had significantly improved from a preoperative logarithm of the minimum angle of resolution (logMAR) of 0.10 (interquartile range [IQR], 0.00-0.60) to 0.02 (IQR, 0.00-0.20) (P < 0.001). The anatomic success rate was 100% for the macula-off subgroup (n = 20), as BCVA improved from 0.75 (IQR, 0.43-1.18) to 0.20 (IQR, 0.04-0.30) logMAR (P < 0.001). Two eyes (3.77%) with recurrent detachment and one eye (1.89%) with a secondary macular epiretinal membrane required subsequent pars plana vitrectomy. CONCLUSIONS: The mPnR procedure is efficient and minimally invasive, expansile gas is not required, and preliminary safety and efficacy profiles were favorable. Therefore, mPnR offers a simplified, feasible surgical option for treating eligible patients with primary RRD.