Introduction
Pneumatic retinopexy is an effective, non-invasive surgical procedure used to repair selected cases of rhegmatogenous retinal detachments. The retina is a structure in the posterior eye that receives and converts light into visual information. When the retina detaches from the eye's inner wall, this is known as retinal detachment. If the condition goes untreated, it can cause vision loss.
A common symptom of retinal detachment is the Increase of floaters in the field of vision. These specks can be so dense that they interfere with the patient's vision. The patient may also experience light flashes in the eye. Certain factors cause retinal detachment. They include:
- Eye disorders such as uveitis
- Previous cataract surgery
- Advanced age
- Eye injury
Pneumatic retinopexy is the commonly selected procedure to treat uncomplicated retinal detachments without inferior or extensive retinal breaks or major proliferative vitreoretinopathy. It is also widely used as the first procedure when fixing retinal detachments as it does not affect the success of subsequent vitrectomy or scleral buckling. The surgery is best suited to manage the following complications:
- Macular and posterior retinal breaks
- Filtering blebs
- Approaching macular detachment
- Redetachment after scleral buckling
- Isolated tears under the superior rectus
- Highly bullous detachment
During the procedure, the surgeon injects an intraocular gas bubble and uses a freezing probe to close retinal breaks. This results in the restoration of blood flow to the retina and helps restore vision. The procedure was introduced in 1986 by Hilton and Grizzard.
Some of pneumatic retinopexy's advantages include:
- It is an outpatient procedure carried out in an eye specialist's office
- No need for general anesthesia
- Fewer risks when compared to other methods used to treat a detached retina
- Causes no change in refractive error
- No diplopia
- Faster recovery when compared to other treatment methods used for detached retina
Some of the procedure's disadvantages include:
- May not be suitable if the patient has a complicated retinal tear
- Requires a highly skilled surgeon to perform the procedure
- Requires patient cooperation and positioning
- A slightly lower success rate in contrast to scleral buckling and pars plana vitrectomy
- Rigorous aftercare steps
Before the Procedure
There are no special preparations required before the surgery. The patient can eat normally and take all their medication as usual. However, the night before the surgery, the patient may be required to fast.
The patient's eyes will be blurry for a few hours after the procedure, so they shouldn't drive home.
Procedure
To begin the procedure, the patient will receive local anesthesia and dilation eye drops. The eyelids and surrounding skin are cleansed with iodine, and a sterile drape is put over the eye. The surgeon then inserts a syringe to do an anterior chamber paracentesis, which is especially helpful in glaucoma patients. About 0.2 ml of aqueous humor is removed.
The specialist injects intraocular gas into a site in a quadrant, away from the detachment. The surgeon has to do this slowly to lower the chances of the "fish eggs" phenomenon. If this happens, the surgeon has to move the bubbles away from the retinal break, allowing them to blend, thus avoiding subretinal gas.
The patient's head is precisely positioned to allow the bubble to move to the retinal detachment and press against it. The bubble flattens the retina until a seal forms between the eye's wall and the retina. The specialist then uses a freezing probe to seal the retinal tear. The gas bubble is slowly absorbed into the eye.
Finally, antibiotics or steroids (or a combination of both) are applied to the eye, and it is patched.
Risks & Complications
Sometimes complications occur from the procedure. The chances of developing these complications depend on age, the level of retinal detachment, and existing medical conditions.
Intraoperative risks include:
- Trapped gas in the pre-hyaloid space
- Raised IOP - This commonly happens during gas injection
- Corneal wound dehiscence
Postoperative risks include:
- Surgical failure
- New or missed breaks in the superior retina
- Presence of subretinal gas
- Persistent or recurrent retinal detachment
- Proliferative vitreoretinopathy
- Choroid detachments
- New retinal tears
- Macular holes
- Bleeding
The patient should immediately contact their doctor if they experience any of the following:
- Increasing vision loss
- Increasing redness, swelling or pain
- Discharge from the eye
- Changes in the field of vision including new floaters or light flashes
Aftercare & Recovery
The patient will be released a few hours after the procedure is complete. The patient is required to wear an eye patch for a day or two. If they experience any pain or soreness, they can take some over-the-counter medication. The specialist will prescribe eye drops with some antibiotics to help curb infection.
A scheduled follow-up appointment will be made a day after the surgery to see whether the procedure was effective. If the retina is flat, another re-examination is planned for one week.
It takes about three weeks to recover fully. One of the vital recovery steps is keeping the gas bubble in the right place. The patient does this is by:
- Staying in a specific position for eight or more hours after the surgery and many more hours for three weeks after that. The specialist will give instructions on how to do this.
- Not lying on their back. If the patient does this, the bubble will move and press the lens instead of the retina.
- Avoiding air travel for a few weeks.
Outcome
The procedure has been proven to have a success rate of 74.5%. After further retinal detachment surgery, this rises to 96%. However, in some instances, the procedure doesn't work. When this happens, the patient may need to have further surgery.
