TY - JOUR
T1 - Pneumatic Retinopexy Versus Pars Plana Vitrectomy for the Management of Retinal Detachment
T2 - A Systematic Review and Meta-Analysis
AU - Roshanshad, Amirhossein
AU - Shirzadi, Saeedreza
AU - Binder, Susanne
AU - Arevalo, J. Fernando
N1 - Funding Information:
No funding or sponsorship was received for this study or the publication of this article. Amirhossein Roshanshad designed the study, gathered, analyzed, and interpreted the data, and wrote the draft. Saeedreza Shirzadi gathered the data and wrote the draft. Susanne Binder helped with study design, writing the draft, and revision. J. Fernando Arevalo contributed to study design, conceptualization, writing the draft, and revision. All authors read and approved the final manuscript. Amirhossein Roshanshad, Saeedreza Shirzadi, and Susanne Binder have no conflicts of interest to declare. J. Fernando Arevalo: Abbvie: consultant/advisor; Genentech: consultant/advisor; Springer SBM LLC: patents/royalty; Elsevier: patents/royalty; Thea Laboratories: consultant/advisor; Topcon Medical Systems Inc.: grant support; DORC: consultant/advisor; EyePoint Pharmaceuticals: consultant/advisor; Alimera Sciences, Inc.: consultant/advisor. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. Data are available from the corresponding author upon reasonable request via email.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/4
Y1 - 2023/4
N2 - Introduction: Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair. Methods: We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1. Results: PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2.25–5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = − 0.58, 95% CI = − 1.16 to 0.00) and post-op (SMD = − 0.45, 95% CI = − 0.60 to − 0.30) LogMAR, the improvement in visual acuity after surgery was higher in PPV patients (SMD = 0.49, 95% CI = − 0.15 to 1.13). Conclusion: The success rate of PnR was higher in studies published after 2015 compared to previous studies (82% vs. 59%). Cataract formation and surgery were significantly higher in the PPV arm, while the occurrence of new retinal tears was more frequent in the PnR group. PnR can be used as the primary procedure for RRD repair in selected cases. However, we propose some modifications to the PIVOT criteria, e.g., the exclusion of cases presenting with several risk factors of poor outcomes.
AB - Introduction: Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair. Methods: We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1. Results: PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2.25–5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = − 0.58, 95% CI = − 1.16 to 0.00) and post-op (SMD = − 0.45, 95% CI = − 0.60 to − 0.30) LogMAR, the improvement in visual acuity after surgery was higher in PPV patients (SMD = 0.49, 95% CI = − 0.15 to 1.13). Conclusion: The success rate of PnR was higher in studies published after 2015 compared to previous studies (82% vs. 59%). Cataract formation and surgery were significantly higher in the PPV arm, while the occurrence of new retinal tears was more frequent in the PnR group. PnR can be used as the primary procedure for RRD repair in selected cases. However, we propose some modifications to the PIVOT criteria, e.g., the exclusion of cases presenting with several risk factors of poor outcomes.
KW - Pars plana vitrectomy
KW - Pneumatic retinopexy
KW - Reattachment
KW - Retinal displacement
KW - Rhegmatogenous retinal detachment
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U2 - 10.1007/s40123-023-00653-9
DO - 10.1007/s40123-023-00653-9
M3 - Review article
C2 - 36717526
AN - SCOPUS:85146982119
SN - 2193-8245
VL - 12
SP - 705
EP - 719
JO - Ophthalmology and Therapy
JF - Ophthalmology and Therapy
IS - 2
ER -