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Mechanism of Retinal Reattachment in Pars Plana Vitrectomy

Some outcomes following pneumatic retinopexy (PnR) may be superior to pars plana vitrectomy (PPV) for managing rhegmatogenous retinal detachment, based on randomized clinical trial findings.

This animation video illustrates a possible mechanism for the difference in visual acuity outcomes between the 2 procedures based on observations of photoreceptor integrity on spectral-domain optical coherence tomography (OCT) after 12 months.

PPV involves a gas-fluid exchange. As gas is put into the vitreous cavity, subretinal fluid at the site of detachment is aspirated. The photoreceptor layer re-apposes to the retinal pigment epithelium (RPE) as the fluid is removed, but cell interdigitation is suboptimal and some photoreceptor cells subsequently die off in the process. This is potentially associated with worse visual acuity outcomes and with more discontinuities of the ellipsoid zone (EZ) and external limiting membrane (ELM) on OCT imaging compared with pneumatic retinopexy.

Click the Related Multimedia link for a parallel video illustration of pneumatic retinopexy and the Related Article link for full details.

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