Postoperative Photoreceptor Integrity Following Pneumatic Retinopexy vs Pars Plana Vitrectomy for Retinal Detachment Repair: A Post Hoc Optical Coherence Tomography Analysis From the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial

Abstract

Importance: Pneumatic retinopexy (PnR) is associated with superior visual acuity and reduced vertical metamorphopsia compared with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). It is important to determine postoperative photoreceptor integrity with both surgical techniques.

Objective: To compare photoreceptor integrity on spectral domain-optical coherence tomography (SD-OCT) between PnR and PPV at 12 months postoperatively.

Design, setting, and participants: Post hoc analysis of the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) conducted between August 2012 and May 2017 at St Michael's Hospital, Toronto, Ontario, Canada. Primary RRDs with specific criteria were included. Data were analyzed between April and August 2020.

Intervention: Randomization to PnR vs PPV stratified by macular status.

Main outcomes and measures: Difference in proportion of patients with discontinuity of the ellipsoid zone (EZ) and external limiting membrane (ELM) between groups assessed independently by 2 masked graders at an external masked image reading center.

Results: A total of 150 participants completed the 12-month follow-up visit. A total of 145 patients (72 PPV and 73 PnR) had gradable spectral-domain optical coherence tomography at 12 months. Analysis of the central 3-mm (foveal) scans found that 24% (n = 17 of 72) vs 7% (n = 5 of 73) displayed EZ discontinuity (difference, 17%; odds ratio [OR], 4.204; 95% CI, 1.458-12.116; P = .005) and 20% (n = 14 of 71) vs 6% (n = 4 of 73) displayed ELM discontinuity (difference, 14%; OR, 4.237; 95% CI, 1.321-13.587; P = .01) in the PPV and PnR groups, respectively. Analysis of the 6-mm (foveal and nonfoveal) scans revealed that EZ and ELM discontinuity was greater in the PPV vs PnR groups (EZ, 32% [n = 23 of 72] vs 11% [n = 8 of 73]; difference, 21%; OR, 3.814; 95% CI, 1.573-9.249; P = .002; ELM, 32% [n = 23 of 71] vs 18% [n = 13 of 73]; difference, 14%; OR, 2.211; 95% CI, 1.015-4.819; P = .04).

Conclusions and relevance: Discontinuity of the EZ and ELM was more common at 12 months postoperatively following PPV vs PnR for RRD repair. The findings of this post hoc analysis suggest that less discontinuity of the EZ and ELM may provide an anatomic basis for the previously reported superior functional outcomes with PnR, although the analysis does not prove a cause-and-effect relationship.

Trial registration: ClinicalTrials.gov Identifier: NCT01639209.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Sadda reported personal fees from Amgen, Allergan, Bayer, Roche/Genentech, Regeneron, Novartis, Oxurion, Astellas, 4DMT, Centervue, Merck, Heidelberg, Carl Zeiss Meditec, Topcon, Nidek, and Optos outside the submitted work. Dr Wong reported personal fees from Bayer, Alcon, Zeiss, Topcon, Abbvie, and Bausch Health; grants from Novartis and Roche; and other support from Artic DX and Ripple Therapeutics outside the submitted work. Dr Kertes reported grants and personal fees from Novartis, Roche, and Bayer; personal fees from Novelty Nobility; and other support from Arctic Dx Equity outside the submitted work. Dr Sarraf reported grants and personal fees from Amgen and Optovue; personal fees from Bayer and Novartis; grants from Genentech and Regeneron; and nonfinancial support from Heidelberg, Optovue, and Topcon outside the submitted work. No other disclosures were reported.

Figures

Figure 1.. Randomization and Follow-up of the Intention-to-Treat Population for the Pneumatic Retinopexy vs Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial

Figure 2.. Spectral-Domain Optical Coherence Tomography (SD-OCT) for Macula-On Detachment Randomized to Pars Plana Vitrectomy (PPV)

Representative SD-OCT 5-line raster images for macula-on detachment randomized to PPV, which became macula off postoperatively (A) and underwent repeated PPV. Secondary reattachment achieved with ellipsoid zone and interdigitation zone discontinuity (arrowheads) at the 12-month follow-up (B).

Figure 3.. Spectral-Domain Optical Coherence Tomography (SD-OCT) for Macula-On Detachment Randomized to Pneumatic Retinopexy (PnR)

Representative SD-OCT 5-line raster images with no discontinuity of the outer retinal layers for macula-on detachment randomized to PnR (A). External limiting membrane, ellipsoid zone (EZ), and interdigitation zone (IZ) discontinuity (arrowhead) in foveal scan of macula-off detachment randomized to pars plana vitrectomy (PPV) (B). The EZ and IZ discontinuity (arrowhead) in foveal scans of macula-off detachment following PPV (C), as well as EZ and IZ discontinuity (arrowhead) in macula-off detachment following initial PnR that failed and underwent subsequent PPV (D).