Advantages of PR

Given an optimal clinical scenario, PR has several advantages over primary PPV and/or SB for the repair of a RRD. Pneumatic retinopexy is usually performed in the office or as a brief procedure in an outpatient surgical facility. In a multicenter trial reported by Tornambe [13], the average number of hospital days including re-operations was 0.6 days for the PR group and 2.7 days for the SB group. The physician spends less time waiting for availability of the operating room, performing the procedure, and performing post-operative hospital rounds. It should be noted, however, that since this publication in 1989, the majority of procedures, including PR, primary PPV, and SB, are now performed in an outpatient setting.

With PR, the patient generally experiences less pain, and there is a quicker recovery in the more comfortable setting of home. There is also a significant economic advantage to the patient and the insurer in terms of cost savings by avoiding the operating room, anesthesia, and hospitalization expenses. It is estimated that the cost of PR is between 25% and 50% of that of SB, including re-operations [14].

Pneumatic retinopexy is a technically easy procedure. There are very few significant intraoperative complications. When they do occur, they generally involve improper location of the injected air or gas, generally into the subretinal space. This is seen in only 0% to 4% of cases [12-15], however, postoperative complications of PR are rare, with the exception of new and/or missed retinal breaks. But ERM, CME, macular hole, and PVR rates are more than or equal to published risk rates for SB and PPV [3,9,11-17,31-60].

Functional visual results of the three techniques is an area of significant controversy. It is well recognized that PR and primary PPV both avoid the significant induced myopia and astigmatism associated with SBs. The induced changes in refractive error can, in some cases, produce significant anisometropia, requiring contact lens use or even refractive surgery. A large multicenter trial comparing SB and PR found a significant visual benefit with PR. For eyes with preoperative macular detachment of less than 2 weeks duration, the percentage of patients achieving 20/50 or better best-corrected visual acuity was 80% for PR and 56% for SB [13]. Two retrospective, comparative series by Han [17] and McAllister [61], however, found no statistically significant difference in visual outcomes between the two procedures. Similar data for primary PPV is unavailable for a meaningful comparison; however, the positive impact of the clearance of vitreous floaters and debris cannot be underestimated.

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