Stephen M. Conti, MD, FRCS(C) (Toronto, Canada), Feisal A. Adatia, MD, MSc (Toronto, Canada), Jaime Claramunt, MD (Toronto, Canada), Howard Chen, MD (Toronto, Canada), Robert G. Devenyi, MD (Toronto, Canada), Wai-Ching Lam, MD, FRCS(C) (Toronto, Canada), Peter J. Kertes, MD, FRCS(C) (Toronto, Canada)


To evaluate and compare the success of pneumatic retinopexy in phakic patients with a primary rhegmatogenous retinal detachment that meet the Clinical Trial Group (CTG) inclusion criteria to those with extended criteria.


Prospective, consecutive, non-randomized, interventional study on all phakic patients who presented with a primary rhegmatogenous retinal detachment where the ora serrata could be examined for 360 degrees and it was reasonable that pneumatic retinopexy could tamponade or sequentially tamponade the causative retinal breaks. CTG were a single retinal break (=1 clock hour) or a cluster of small breaks not exceeding 1 clock hour, all breaks were superior to the 4:00 and 8:00 meridians, and lattice degeneration was =3 clock hours. Extended criteria were a single break or multiple breaks spanning >1 clock hour, having a retinal break(s) in attached retina, or extensive lattice degeneration.


Of 65 consecutive primary phakic retinal detachments that presented 81.5% (53/65) were candidates for pneumatic retinopexy, 51 gave informed consent and were enrolled. Pneumatic retinopexy was successful in 34/38 (89.5%) that met CTG criteria and in 10/13 (76.9%) that met extended criteria. Of patients with extended criteria: 7/9 (77.7%) were successful with retinal breaks greater than 1 clock hour apart, 2/3 (66.6%) with an additional retinal break in attached retina, and 1 patient with lattice degeneration greater than 4 clock hours was successfully treated. Vitrectomy was performed for all failures; 4/4 CTG patients were successfully managed with a mean of 1.33 surgeries (2 with gas tamponade and 2 with silicone oil) and 3/3 in the extended criteria group were managed with a mean of 1 vitrectomy with gas tamponade.


The majority (67%) of phakic patients in this consecutive series could be managed with pneumatic retinopexy alone. Extended criteria phakic patients do well with pneumatic retinopexy as a primary treatment option, and do not appear disadvantaged in comparison to CTG patients if pneumatic retinopexy fails.