Rajeev Muni: Pneumatic Retinopexy vs. Vitrectomy

Rajeev Muni, MD: Over the last several years, we've been doing a randomized clinical trial that compares pneumatic retinopexy, which is where we inject a gas bubble into the eye, compared to vitrectomy. One of the significant differences between the 2 treatments is that patients who have vitrectomy subsequently require cataract surgeries, usually within 6 months to a year, and because of the fact that many of these patients are highly myopic, it ends up that they actually eventually need cataract surgery in their other eye just to balance their vision.

To summarize the results of the study, we included a broad range of retinal detachment patients and we found that those patients who had pneumatic retinopexy first did better in terms of their final visual acuity at 1 year. Even though patients who have pneumatic may subsequently need a secondary operative procedure in 12% more cases than those who had vitrectomy, overall, the final visual acuity was still better in those patients who had pneumatic retinopexy first.

We feel that you know, this study is somewhat of a game-changer as vitrectomy is really the most common method of fixing both phakic and pseudo phakic retinal detachments and we feel that patients who met the PIVOTS study criteria should be offered a pneumatic retinopexy before vitrectomy.

When retinal surgeons are questioned what their most common method of treating phakic retinal detachments in the US, it's vitrectomy. If you look at what the most common method of treating pseudo phakic retinal detachments internationally, it’s vitrectomy. I believe that the results of this study demonstrated that those patients who meet the inclusion criteria of this study, which are fairly broad and applied to many retinal detachments, should, in fact, be offered pneumatic retinopexy first, as their final visual acuity will be better with this treatment compared to vitrectomy.