Pneumatic retinopexy: a review of an essential technique in vitreoretinal surgical care

Introduction: Recently, there has been increasing evidence supporting the use of pneumatic retinopexy (PnR), a minimally invasive procedure for rhegmatogenous retinal detachment (RRD). Areas covered: This review discusses the indications of PnR, principles and guidelines to perform the procedure, and advantages relative to other surgical methods. Landmark trials that compared PnR to other surgical interventions for RRD are reviewed. We also examine cost analyses comparing PnR to PPV. Finally, we address the critiques and latest advances in the use of PnR. Expert opinion: PnR has been found to be superior in terms of visual acuity at one year, vertical metamorphopsia at one year, and vision-related quality of life in the first 6 months, with less morbidity relative to pars plana vitrectomy (PPV). Relative to scleral buckle (SB), PnR had fewer adverse events and a higher proportion of macula-off patients achieving a visual acuity of 20/50 or better. Although PnR is associated with a lower primary reattachment rate compared to PPV or SB, final reattachment rate after subsequent interventions is comparable. PnR should be offered first-line to patients with RRD meeting clinical trial criteria to maximize functional outcomes.