Minimally invasive retinal reattachment procedure leads to enhanced photoreceptor integrity

David Hutton

A study led by investigators at St. Michael's Hospital of Unity Health Toronto supports pneumatic retinopexy as a primary retinal reattachment technique to achieve better long-term integrity of photoreceptors.

A minimally invasive retinal reattachment procedure, which can be performed in an ophthalmologist’s office, may offer improved long-term integrity and structure of the retina's photoreceptors compared with more invasive operating room procedures, according to new research.

The study was led by investigators at St. Michael's Hospital of Unity Health Toronto, contributes to a growing body of evidence pointing towards pneumatic retinopexy (PnR) as the better first-line retinal reattachment technique to achieve the best visual outcomes.

According to investigators, retinal detachment is the most common surgical ocular emergency, progressing to loss of vision within hours or days. While there are a number of different treatment options, there is limited high-quality data guiding the choice of surgery.

"Our study shows there is a difference in the long-term integrity of the photoreceptors between different surgical techniques, and these anatomic differences were associated with visual outcomes," co-principal investigator Rajeev H. Muni, MD, a vitreoretinal surgeon at St. Michael’s and researcher at the Li Ka Shing Knowledge Institute, said in a statement.

During previous studies carried out at St. Michael’s Hospital, patients had better visual results following the less invasive PnR compared to pars plana vitrectomy (PPV). In the study, the investigators determined there was an actual difference in photoreceptor anatomic recovery between the two retinal reattachment techniques.

Using data from a randomly assigned trial conducted at St. Michael’s Hospital, investigators compared the retinal scans of 72 patients who had retinal reattachment using PPV and 73 patients who had retinal reattachment using the minimally invasive PnR at 12 months post-operatively.

According to investigators, PnR offers ophthalmologists a less invasive and less expensive retinal reattachment technique that can be done in the office. In PnR, a small gas bubble is used to close the retinal tear and allow the fluid to reabsorb naturally and slowly. PPV is a surgical technique where the fluid under the retina is rapidly aspirated and removed, forcefully bringing the retina back in position.

Investigators found that the imaging showed that discontinuity was more common at 12 months post-operatively among patients who had the PPV surgical reattachment than in patients who had the minimally invasive PnR procedure. The discontinuity indicates damage to cells that are critical for vision and this damage was found to be associated with worse visual outcomes.

“This data provides an objectively determined anatomic basis for the superior functional outcomes seen with pneumatic retinopexy that we have previously reported," according to Roxane J. Hillier, MD, the trial's other co-principal investigator who is now based in the United Kingdom.

The researchers say their findings highlight that closing the retinal tear, doing as little else as possible, and allowing the retina to reattach naturally leads to the best outcomes both from an anatomic and visual perspective.

"This was previously unknown, and in my opinion will be a game-changer in our field," Dr. Muni concluded.

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Reference

1 Rajeev H. Muni, MD; Tina Felfeli, MD; Srinivas R. Sada, MD; et al; Postoperative Photoreceptor Integrity Following Pneumatic Retinopathy vs Pars Plana Vitrectomy for Retinal Detachment Repair; JAMA Ophthalmol. Published online April 22, 2021. doi:10.1001/jamaophthalmol.2021.0803