What is Pneumatic Retinopexy?
Pneumatic retinopexy is an in-office procedure used to repair certain types of retinal detachments. Pneumatic retinopexy typically treats rhegmatous retinal detachments. The eye is numbed with anesthesia so there is no pain. A gas bubble is injected into the eye (vitreous cavity). When the gas floats up, it pushes the retina that is detached back into proper position and also closes the retinal tear against the way of the eye at the same time, thus repairing the retinal detachment. Cryopexy (freezing) or laser are then used to permanently seal the retinal tear to the wall of the eye. The gas bubble goes away by itself, getting smaller and smaller over the course of 4-8 weeks, after which, if successful, the retina should be back to its proper position and the vision should be improved.
Why is a Pneumatic Retinopexy Surgery Performed?
Pneumatic retinopexy is done for certain types of retinal detachments, typically for rhegmatous retinal detachments. It can be useful when:
- The retinal tear causing the detachment is in the upper part of the retina
You will need to hold your head in a certain position after the gas bubble is injected into your eye. For example, if the retinal tear is at 12 o’clock position, you simply need to sit or stand upright for the gas to float up and close the retinal tear from the inside of the eye. If the retinal tear is at 10 o’clock position, you may need to position your head with a slight tilt. Your retina surgeon will tell you how to position your head for the first few days or week, while the gas bubble is working to reattach your retina.
Pneumatic retinopexy is usually not used for retinal tears that are at 6 o’clock position (bottom of the retina) as the gas likes to float up, and you would need to keep your head upside down to achieve the goal of the gas bubble pushing the retina back into place and closing the retinal tear. This is usually not practical, but may be used in rare circumstances.
How Do You Prepare for the Surgery?
The most important thing to do is discuss with your retina specialist the positioning of your head that you will need to hold for the pneumatic retinopexy to be successful, and for how long you will have to hold that position. Often, the head needs to be tilted to the side for up to one week, day and night. For some people, this is not a problem, and they are able to correctly position for the appropriate amount of time until the retina reattaches. For others, often with neck or back issues, or other medical issues, they are unable to position properly for such a long period of time. This should be communicated to your retina specialist, as you may not be a good candidate for pneumatic retinopexy.
Furthermore, you should discuss with your retina specialist the success rate of pneumatic retinopexy with your specific retinal detachment and your specific ability to position your head. Every situation is different, and you should know what to expect prior to the procedure. If the pneumatic retinopexy is successful, then you can often avoid going to the operating room for surgery, but often surgery is needed to repair the retina in addition to a pneumatic retinopexy. These discussions are important to have prior to any procedure.
Your eye will be dilated and a retina exam performed prior to the procedure, but otherwise, there is nothing that needs to be done to prepare.
How Long Will the Pneumatic Retinopexy Surgery Take?
Pneumatic retinopexy is typically completed within 30 minutes. The procedure itself lasts about a minute, but most of the time is in numbing the eye, so that you feel no pain during the procedure.
What Can You Expect During the Surgery?
Pneumatic retinopexy is a fairly quick procedure. Here are the simplified steps for the pneumatic retinopexy surgery:
- The retina specialist will typically first examine your eye before the procedure.
- Your eye is numbed with local anesthesia before surgery, including numbing eye drops and numbing eye gel
- Then the retina specialist injects a gas bubble into the vitreous, or middle of the eye, and will position you so that the retinal tear sits at 12 o’clock, such that when the gas floats up (which is what it will always do) it will push the retinal tear closed and push the retina back in to proper position.
- The retina specialist may use a freezing device to seal the retina against the wall of the eye prior to the gas bubble injection or may use a laser to seal the tear a few days after the injection once the retina has begun reattaching
- Once the retina doctor makes sure the bubble is in the correct place, the eye is re-evaluated to be sure eye pressure is normal, check the blood flow in the retina and check the vision. This is done immediately after the procedure.
- To decrease the risk of infection an antibiotic ointment will be applied to your eye and dispensed to be used by you at home after the procedure.
- Then to protect your eye, an eye patch may be applied to cover your eye.
What are Follow-up and Recovery Like for Pneumatic Retinopexy?
Be sure to ask your retina specialist about what you should expect after your procedure. Be sure to plan ahead and have someone help you home after the procedure.
It is important to follow the retina specialist’s instructions about your eye’s aftercare.
To decrease the risk of infection, you may be prescribed eye drops with an antibiotic.
If the eye is sore after the procedure, you should be able to take over-the-counter pain medications, such as tylenol.
You also may need to wear an eye patch for a day or so after the procedure.
Your retinal specialist will give you specific instructions about how to position your head after the procedure. It is very important to follow all instructions to give your retina the best chance to reattach after this procedure.
It is important to understand that you may need to keep a certain head position for almost the entirety of 3-7 days after the procedure. If you are unable to position your head as recommended, you should mention this to your retina specialist prior to the pneumatic retinopexy, as this procedure may not be the right treatment choice for you.
The benefits of a pneumatic retinopexy are that, if successful, you can repair your retinal detachment with a quick procedure in the office and you can avoid surgery in an operating room. The disadvantage of pneumatic retinopexy is that you must keep your head in a very specific position very strictly for days at a time. If the positioning is not an issue for you, and your retinal tear is in the upper part of your retina, this may be a good treatment option for you. If, however, you are unable to keep the recommended positioning, or the retinal tear is not in the upper part of your retina this may not be an ideal procedure of you.
To avoid complications and excess pressure in your eye, you will not be able to fly on an airplane or go up elevation (drive up a mountain) while you have a gas bubble in your eye. If you fly on an airplane with a gas bubble in your eye, the gas bubble will expand and cause increased pressure within your eye. This will likely cause severe pain and may lead to permanent blindness. Therefore, it is strictly prohibited as long as the gas bubble is in your eye.
It typically takes up to 1 week of strict head positioning after pneumatic retinopexy. After the first week, if the retina healed well, you may return to work.
You will need to wait until the gas bubble is completely gone to return to full physical activity and exercise. This often takes 4-8 weeks Every situation is different, so for the exact timeline, consult with your retina specialist.
You will need close follow-up care with your retina specialist to see whether the procedure was effective and the retina successfully reattached. You will have scheduled appointments for the first few weeks after the procedure for close monitoring.
Be sure to tell your eye doctor right away if you have decreasing vision or increasing pain or swelling around your eye.
If the procedure is not a success in repairing the retinal detachment, you will likely need to have surgery.
Contact your doctor right away if you notice any problems after surgery, such as:
- Decreasing vision.
- Any sign of infection. This could include increased pain, swelling, or redness around the eye.
- Any discharge from the eye.
- Any new floaters, flashes of light, or other changes in your field of vision, such as a shadow or curtain in your vision.
What are the potential surgical risks?
Most people do well with their pneumatic retinopexy, but complications can sometimes occur. Risks should be discussed with your retina specialist prior to this, or any, procedure. Here are some common risks.
Most common risk of pneumatic retinopexy:
- Worsening of retinal detachment even with pneumatic retinopexy, necessitating surgery to repair.
Other common risks of the procedure include:
- Proliferative vitreoretinopathy- a scar-like process on the retina that can cause new holes or detachment and needs surgery to repair. This occurs in up to 10% of patients that have a retinal detachment for unknown reasons
- Gas trapped in the front of the eye needing removal in the office or with surgery
- High pressure in the eye that needs drops, pills or surgery to correct
- Bleeding in the eye
Rare, but severe risks for almost all invasive eye procedures (including pneumatic retinopexy):
- Severe infection that may cause blindness or loss eye
- Severe bleeding that may cause blindness
Other less common risks are:
- Retinal folds
- Eye inflammation
Select Relevant Publications
Feistmann Jonathan, Prasad S, Gentile RC, Kasuga DT, Bhullar SS, Joshi DD. Bimanual Approach to Intraocular Lens Rescue Using Modified Transconjunctival Scleral Fixation. Retina Today. 2014;34(4):812-815. Link to Article.
Jonathan A. Feistmann, MD,PC, Reginald J. Sanders, MD. Transitioning to ICD-10: Will the Disruption Be Worth It?. Retina Times. Fall 2015; 61. Link to Article.