Minimally invasive retinal detachment surgery gives patients more accurate vision, with less visual distortion and fewer side effects. It is also less expensive.
In proven retinal detachment, the treatment is surgery and the most common technique offered is an operation called “vitrectomy” which involves removing the vitreous body inside the eye to surgically repair the retina and reapply it on the fundus by various methods.
The results of this comparative study between 2 surgical techniques, pneumatic retinopexy, a minimally invasive technique, and vitrectomy, clearly demonstrate that retinal detachments will obtain better results with minimally invasive surgery such as pneumatic retinopexy compared to traditional surgery, vitrectomy.
The results are published in Ophthalmology, the journal of the American Academy of Ophthalmology.
A randomized study
The study looked at 176 people with a diagnosis of retinal detachment who were randomly assigned to either pneumatic retinopexy or vitrectomy. The primary endpoint was visual acuity one year after surgery, as well as a metamorphopsia score, to assess visual distortions, and anatomical success.
Improved visual acuity
Patients who had pneumatic retinopexy were able to read an average of 4.9 letters more on the standardized visual acuity test compared to those who had vitrectomy. Moreover, with pneumatic retinopexy, the patients had less visual distortions.
Good functional results
A greater proportion of patients who had pneumatic retinopexy achieved 20/40 vision in the affected eye (90.3% vs. 75.3%). Although patients treated with vitrectomy had higher anatomical success rates (93.2% versus 80.8%), patients who did not achieve anatomical success with pneumatic retinopexy still achieved very good results. visual results. Moreover, secondarily, the anatomical success is practically identical between the 2 groups.
Patients in the pneumatic retinopexy group also report faster recovery and better quality of life within six months of surgery.
A surgical indication
The retina is a membrane that lines the back of the eye. It contains sensory cells which t analyze the light signals transmitted through the pupil of the eye and the lens. The information is then transmitted by the optic nerve to the brain which reconstructs, ultimately, the image.
Retinal detachment is due to the presence of a small pocket of fluid located under the retina. In the vast majority of cases, retinal detachment follows a tear in the retina which allows fluid that is normally inside the eye to leak in and lift the retina step by step. The detached area no longer works and the risk is that without prompt treatment, the detachment will continue.
A technique underused in Europe
According to Dr. Rajeev H. Muni, principal investigator of the study and vitreoretinal surgeon at St. Michael’s in Great Britain, the main result of the study is that better vision results are obtained with the mini-treatment. invasive by pneumatic retinopexy (or PnR).
This study should change the way most retinal specialists treat simple retinal detachments, especially since it is a less expensive technique to perform than vitrectomy.
One of the disadvantages of vitrectomy is that many patients will require a second operation, cataract surgery, within a year. This significantly delays visual recovery and can be mostly avoided with pneumatic retinopexy treatment.
Handicap improvement
According to the experts, this trial is also the first to demonstrate that pneumatic retinopexy can minimize the visual distortion that can appear after treatment for retinal detachment. This would potentially avoid the “Picasso effect”, which in some patients causes a significant deterioration in their vision.
Indeed, in this case, if the patients can read the letters during the tests, everything is distorted in reality and many people end up learning to completely ignore the diseased eye. This problem of visual distortion is therefore very debilitating for patients, and the fact that it can be minimized with pneumatic retinopexy is probably linked to the better quality of retinal recovery obtained with this technique.
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