Primary Retinal Detachment

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