1. Pneumatic Retinopexy
for Dummies
By N.W

2. Retinal Detachment

What happens

Vitreous degeneration
Vitreous syneresis
 Posterior vitreous detachment (PVD)

Retinal break
 Retinal detachment


3. 1. Vitreous syneresis

4. 2. Posterior vitreous detachment
(PVD)

5. PVD: C/S vitreo-retinal adhesion

6. 3. Retinal Break

7. 4. Retinal detachment

8. 5. Vitreous hemorrhage

9. Treatment : RB

RB  laser/ cryo

10. Treatment : RD

Rules

1. retinal reattachment
Scleral buckling
 Vitrectomy with gas/ oil
 Pneumatic retinopexy


2. Create adhesion force to prevent redetachment
Laser
 Cryo


11. Retinal reattachment 1 : scleral
buckling

12. Retinal reattachment 2 :
vitrectomy with gas/oil

13. Retinal reattachment 3 :
pneumatic retinopexy

14. Create adhesion force to prevent
redetachment 1 : cryo

15. Create adhesion force to prevent
redetachment 2 : laser

16. PNEUMATIC RETINOPEXY

17. Pneumatic retinopexy
A procedure for retinal reattachment
 Intravitreal gas injection
 Transconjunctival cryopexy /
Laser photocoagulation
 Appropriate head positioning

18. History





1911 : Ohm, 1ST intravitreal air injection for RD.
1938 : Rosengren, using intravitreal air with
SRF drainage.
1973 : Norton, using intravitreal SF6 with SB or
vitrectomy.
1985 : Blodi, using intravitreal gas for MH with
detachment.
Hilton & Grizzard, using the term “PR”.
1989 : Tornambe & Hilton, comparing PR with SB.

19. Gas Injection
Buoyant Force
Tamponade Effect
Gas occluding retinal break
Preventing fluid influx through the hole
Inferior SRF displacement
Re-absorption of SRF
Retina Reattachment

20. What to inject

Small amount of gas bubble


Expand to required volume


High percentage
N2, O2, CO2
Non toxic

22. types of gas in use
 LESS solubility


 MORE expansion
Solubility
: C3F8 < SF6 < AIR
Average expansion : 4x : 2x : x

23. Retina – Gas interface
The relationship between
bubble volume & area of tamponade

24. 
In normal outflow channels, 20 – 25 % of
vitreous volume may be replaced by gas without
an abnormal rising in IOP.
AIR : ~ 1.2 ml used
SF6 : ~ 0.6 ml used
C3F8 : ~ 0.3 ml used

25. 
The most rapid rate of volume expansion
occurs within the first 6- 8 hrs, so IOP should
be monitored during this period.

28. Initial criterias for PR






Size of break : No greater than 1 clock hour
Site of breaks : Superior 2/3 of the fundus
PVR : GR. A or B
Ability to maintain position
No Hx of Severe Glaucoma
No Cloudy media

29. Expanded criterias

Breaks extension : Single or multiple tears
which spanning up to 3 clock hours

30. What about RD with Inferior
break(s)?

31. Inverted PR

32. “ Inverted PR can successfully repaired
RRD with the inferior retinal breaks under a
ppropriate condition ”

33. Complications



-
Corneal edema
Posterior corneal membrane formation
Cataract formation
Resulting from deprivation of nutrient effect
than from a toxic effect
Glaucoma
Endophthalmisis
Subretinal gas/ fish eggs