Pneumatic Retinopexy Provides Better Photoreceptor Integrity Than Pars Plana Vitrectomy

Back Of Eye. Fluorescein Angiography. (Photo By BSIP/UIG Via Getty Images)
Patients who underwent pneumatic retinopexy had less discontinuity of the ellipsoid zone and external limiting membrane.

Postoperative photoreceptor integrity can vary with surgical technique. However, pneumatic retinopexy (PnR) is associated with superior photoreceptor integrity at 12 months postoperatively compared with pars plana vitrectomy (PPV), according to research findings published in JAMA Ophthalmology.

The Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) was a randomized clinical trial that compared PnR with PPV for primary rhegmatogenous retinal detachment. The primary measurement for the study was Early Treatment Diabetic Retinopathy Study (ETDRS) score at 1 year. Researchers had found that ETDRS letter score was superior at every point for PnR compared with PPV. 

Armed with those findings, investigators wanted to examine if postoperative photoreceptor integrity varies by surgical technique. They compared photoreceptor integrity of postoperative patients using spectral domain-optical coherence tomography (SD-OCT) images.

In this post-hoc study, 150 participants completed the 12-month follow-up visit. A total of 145 patients (72 PPV and 73 PnR) had gradable SD-OCT at 12 months. Patients undergoing PnR had less discontinuity of the ellipsoid zone and external limiting membrane on OCT compared with PPV at 12 months postoperatively. Ellipsoid zone and external limiting membrane discontinuity were associated with worse ETDRS visual acuity at 12 months postoperatively.

More specifically, an analysis of the central 3 mm (foveal) scans found that 24% (n=17 of 72) compared with 7% (n=5 of 73) displayed ellipsoid zone discontinuity (difference, 17%; OR, 4.204; 95% CI, 1.458 to 12.116; P =.005) and 20% (n=14 of 71) vs 6% (n=4 of 73) displayed external limiting membrane discontinuity (difference, 14%; OR, 4.237; 95% CI, 1.321 to 13.587; P =.01) in the PPV and PnR groups, respectively. An analysis of the 6 mm (foveal and nonfoveal) scans found that ellipsoid zone and external limiting membrane discontinuity was greater in the PPV than in the PnR groups (ellipsoid zone, 32% [n=23 of 72] vs 11% [n=8 of 73]; difference, 21%; OR, 3.814; 95% CI, 1.573 to 9.249; P =.002; external limiting membrane, 32% [n=23 of 71] vs 18% [n=13 of 73]; difference, 14%; OR, 2.211; 95% CI, 1.015 to 4.819; P =.04).

Limitations of this study include its post-hoc nature and the use of ellipsoid zone and external limiting membrane discontinuity on the foveal 5-line raster scan as the 2 primary outcomes. Investigators did not adjust for multiple comparisons in the analysis.

Disclosure: Some of the study’s authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Muni RH, Felfeli T, Sadda SR, et al. Postoperative photoreceptor integrity following pneumatic retinopathy vs pars plana vitrectomy for retinal detachment repair: a post hoc optical coherence tomography analysis from the pneumatic retinopexy versus vitrectomy for the management of primary rhegmatogenous retinal detachment outcomes randomized trial. JAMA Ophthalmol. Published online April 22, 2021. doi:10.1001/jamaophthalmol.2021.0803