Tornambe P E
Retina Consultants, San Diego, USA.
Trans Am Ophthalmol Soc. 1997;95:551-78.
Pneumatic retinopexy is an operation for reattaching the retina by injecting an expanding gas bubble and using laser and/or cryopexy. The procedure is controversial because the literature reports a variable initial success rate, sometimes less than conventional scleral buckling surgery. PR is done in an office setting and may be the most cost-effective means of retinal reattachment.
The goal of this study is to decide which eyes are most successfully treated with pneumatic retinopexy, and which pneumatic technique is most effective.
Three hundred two (302) consecutive retinal detachments treated by one surgeon with pneumatic retinopexy and followed for six months to ten years were reviewed. Risk factors for failure were detected. The cost of treating eyes with pneumatic retinopexy and scleral buckling was compared using Medicare reimbursement rates.
The average single operation success (SOS) rate for all 302 cases was 68%; 95% were ultimately attached with additional surgery. Factors adversely affecting SOS included pseudophakia/aphakia, the extent of the retinal detachment, and the number of retinal breaks. Factors not influencing SOS included the type of retinal break, the presence of lattice degeneration, the type, volume and sequence of gas injection, retinopexy with laser or cryotherapy, and gender. Complete 360 degrees peripheral retinopexy between the insertion of the vitreous base and ora serrata significantly improved SOS. A 97% SOS rate was detected for a subgroup of eyes. This subgroup included phakic eyes with one quadrant of the retina detached, and one retinal break located in the upper two-thirds of the fundus. Treatment included 360 degrees of peripheral retinopexy. Factors positively influencing visual recovery included SOS, better preoperative acuity, macular attachment, duration of macular detachment less than eight days, and younger age. Eighty-six percent of eyes cured with a single operation attained 20/40 or better acuity. The cost of repairing these 302 cases with pneumatic retinopexy, including reoperations, was estimated to be approximately half the cost of repairing a similar group with scleral buckling. With careful patient selection and peripheral 360 degrees retinopexy, the cost of PR may be one quarter the cost of scleral buckling.
Success with PR, as with other surgical procedures, depends upon proper case selection and surgical technique. Ideal case selection and peripheral 360 degrees retinopexy can increase the SOS rate to 97%. Even with reoperations, PR is more cost effective than scleral buckling.
气体视网膜固定术是一种通过注入膨胀的气泡并使用激光和/或冷冻疗法来使视网膜复位的手术。该手术存在争议，因为文献报道其初始成功率不一，有时低于传统的巩膜扣带术。气体视网膜固定术在门诊进行，可能是视网膜复位最具成本效益的方法。
本研究的目的是确定哪些眼睛采用气体视网膜固定术治疗最成功，以及哪种气体技术最有效。
回顾了由一位外科医生采用气体视网膜固定术治疗并随访6个月至10年的302例连续视网膜脱离病例。检测失败的危险因素。使用医疗保险报销率比较气体视网膜固定术和巩膜扣带术治疗眼睛的成本。
所有302例病例的单次手术成功率（SOS）平均为68%；95%的病例最终通过额外手术实现视网膜复位。对SOS产生不利影响的因素包括人工晶状体眼/无晶状体眼、视网膜脱离的范围以及视网膜裂孔的数量。不影响SOS的因素包括视网膜裂孔的类型、格子样变性的存在、气体注入的类型、体积和顺序、激光或冷冻疗法的视网膜固定术以及性别。在玻璃体基底部插入处和锯齿缘之间进行完整的360度周边视网膜固定术可显著提高SOS。在一组亚组眼睛中检测到97%的SOS率。该亚组包括晶状体眼，视网膜脱离一个象限，且一个视网膜裂孔位于眼底上三分之二处。治疗包括360度周边视网膜固定术。对视力恢复产生积极影响的因素包括SOS、术前视力较好、黄斑复位、黄斑脱离持续时间少于8天以及年龄较小。单次手术治愈的眼睛中有86%达到20/40或更好的视力。用气体视网膜固定术修复这302例病例的成本，包括再次手术，估计约为用巩膜扣带术修复类似病例组成本的一半。通过仔细选择患者并进行360度周边视网膜固定术，气体视网膜固定术的成本可能是巩膜扣带术成本的四分之一。
与其他外科手术一样，气体视网膜固定术的成功取决于正确的病例选择和手术技术。理想的病例选择和360度周边视网膜固定术可将SOS率提高到97%。即使进行再次手术，气体视网膜固定术也比巩膜扣带术更具成本效益。
