Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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Chapter 4<br />
Pneumatic Retinopexy for <strong>Primary</strong> <strong>Retinal</strong><br />
<strong>Detachment</strong><br />
Eric R. Holz, William F. Mieler<br />
Introduction<br />
Pneumatic retinopexy (PR) is a minimally invasive surgical technique<br />
utilized for the repair of rhegmatogenous retinal detachment<br />
(RRD).It is composed of intravitreal gas injection,either cryopexy or<br />
laser, and postoperative patient positioning. Historically, the first<br />
report of the use of intraocular gas injection for the treatment of<br />
RRD appeared in 1911 [1]. Rosengren, in 1938, reported the first large<br />
series of patients treated with intraocular air injection, drainage of<br />
subretinal fluid (SRF), and diathermy [2]. The modern PR technique<br />
was born in 1985 with simultaneous reports by Hilton and Grizzard<br />
in the United States [3] and Dominguez in Spain [4, 5].<br />
The PR procedure appears to be gaining in popularity, although<br />
there is considerable variation in its use based on geography and<br />
practitioner’s years in practice. Surveys of American vitreoretinal<br />
specialists in 1990 and 1997 revealed an increase in use from 38% to<br />
55% for a given “ideal” clinical scenario. There was significant variation<br />
in the choice of surgical technique based on surgeon age.<br />
Those in practice less than 10 years chose PR 65% of the time compared<br />
with 35% of those in practice 20 years or more. Within the<br />
United States, there was regional variation with 74% of survey<br />
respondents in western states choosing PR compared with 43% in<br />
north central states [6].<br />
The rise in the popularity of PR may be due to the perceived<br />
benefits to the patient, the attending physician, and society as a<br />
whole. Well-informed patients typically prefer PR because of its