Patients who underwent rhegmatogenous retinal detachment (RRD) repair with pars plana vitrectomy (PPV) were more likely to develop outer retinal folds (ORFs) compared with patients who underwent pneumatic retinopexy (PnR), according to study results published in Ophthalmology Retina.

The researchers analyzed participants in the Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT NCT01639209). ORFs, which can follow RRD repair, delay retinal reattachment. The objective of the current study was to determine whether PnR and PPV have different risks of developing ORFs.

The researchers determined presence, size, angulation and distance from the fovea of ORFs of 83 PIVOT participants (60.2% men; mean age 62.4±8.38 years) macula-off RRD with gradable macular cube via optical coherence tomography (OCT) at the 1-month postoperative visit. Intergrader agreement for ORF detection was 95.2%.

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PPV was associated with an elevated risk of ORFs at 1-month post-operation (14 of 41 PPV cases vs 6 of 42 PnR cases OR 3.11 P =.034). Three months after operation, 4 patients in the PPV group and 3 patients in the PnR group had ORFs (OR 1.41). Six months after operation, ORFs remained in 1 patient who underwent PPV.

Patients with ORFs at 1 month after operation had a mean 9.4 fewer ETDRS letters compared with patients who did not have ORF formation (P =.047). Shortest distance of ORF from fovea was linked with reduced vertical metamorphopsia score (r=0.507 P =.045).

In a sensitivity analysis, investigators learned that, among patients who underwent PPV, those with ORFs at 1 month had a mean 12.6 fewer ETDRS letters at 1 year compared with patients who did not have ORFs (P =.04).

“This study adds to the increasing evidence that PnR should be strongly considered in patients meeting clinical trial criteria to minimise likelihood of potentially avoidable post-operative anatomic abnormalities that can occur with other treatment approaches such as PPV,” the research says.

Limitations of the study included that it was a post hoc analysis of a randomized trial with a small sample.


Lee WW, Bansal A, Sadda S, et al. Outer retinal folds following pars plana vitrectomy vs pneumatic retinopexy for retinal 2 detachment repair: post hoc analysis from PIVOT. Ophthalmol Retina. Published online September 11, 2021. doi: 10.1016/j.oret.2021.09.001