What is pneumatic retinopexy?

Pneumatic retinopexy is a procedure for repairing a retinal detachment. Unlike scleral buckling or vitrectomy — alternative treatments for retinal detachment — pneumatic retinopexy can be done in the office, without a trip to the operating room. In pneumatic retinopexy, the retina is reattached using a combination of a freezing treatment and injection of a gas bubble into the eye.

How is pneumatic retinopexy done?

Like most procedures, pneumatic retinopexy consists of several steps:

1. Anesthesia
Since the procedure is performed in the office, local anesthesia is used without intravenous sedation. Some retina specialists prefer to inject numbing medicine just under the skin-like covering (the conjunctiva) over the white of the eye (the sclera). This method is essentially painless but only numbs the surface of the eye. Other retina specialists prefer to inject the numbing medicine behind the eye. This technique is typically less comfortable than injecting the medicine under the conjunctiva but tends to numb the eye more thoroughly.

2. Cryopexy
While looking into the eye with a specialized light mounted on a headset, the doctor places a freezing probe on the surface of the eye. Once the probe is in the correct position, the doctor presses a pedal that activates the probe. The entire thickness of the eye wall is frozen, from the white of the eye to the retina. The purpose of this step is to create an adhesive scar around any tears in the retina. You can think of this step as stapling the wallpaper to the wall.

3. Injection of a gas bubble
Before the injection, the surface of the eye is cleaned with iodine to minimize the risk of infection. A very small needle is the used to inject a gas bubble into the eye, through the sclera. The purpose of the gas bubble is to cover the retinal tear while an adhesive scar develops around it.

4. Positioning
The doctor will often ask the patient to maintain a certain position most of the time for several days after the procedure. The position will depend on the location of the retinal tear; a position will be chosen so that the gas bubble covers the tear. Following the doctor’s positioning instructions will help to maximize the chance of a successful result.

Why isn’t pneumatic retinopexy done for every retinal detachment?

Pneumatic retinopexy can be an effective treatment for retinal detachment, but it is not ideal for every case. Patients who have not yet had cataract surgery and have only one tear in the upper part of the retina are the best candidates for pneumatic retinopexy; it is less likely to be successful in patients who do not fit this description. Some patients who could be good candidates for pneumatic retinopexy undergo scleral buckling instead, because scleral buckling is thought by most retina specialists to have a slightly higher success rate.