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Case of the month: August 2021

Bay Area Retina Associates surgeon Dr. Roger Goldberg writes about a case of a retinal detachment repaired with pneumatic retinopexy in the August case of the month. For certain types of retinal detachment, a pneumatic retinopexy is a great option that can be performed in clinic, and avoid the need for major eye surgery while producing great vision outcomes.

Retinal detachment repaired with pneumatic retinopexy

A 70-year old woman was referred urgently to Bay Area Retina Associates, where she was seen by Dr. Roger A. Goldberg. Her vision in the right eye had dropped to ”Count Fingers” (she could not even read the big E on an eye chart), and she was found to have a retinal detachment involving the macula (the center of her retina). After discussing the various treatment options, Dr. Goldberg proceeded to perform a pneumatic retinopexy in clinic that day. In this procedure, a “cryo” probe was used to freeze around the retinal tear that caused the retinal detachment, and a gas bubble was injected into the eye. The patient positions their head so that the bubble floats over the retinal tear, plugging the hole and allowing the eye to use its natural mechanisms to pump the fluid out from under the retina. The freezing procedure creates a small peripheral scar to seal the retinal tear to prevent fluid from coming back under the retina once the bubble dissipates.

The patient is seen the next day in clinic. Often, the fluid under the retina is much better, but often the retinal detachment is not completely resolved by this time. The eye is carefully inspected to assess the retinal detachment, look for new tears, and review positioning instructions. In this picture, the gas bubble is visible in the top of the photograph, and while the retinal detachment is significantly improved, there is still some residual fluid, and the patient needs to continue positioning for 5 days total.

1 week after the pneumatic retinopexy, the retina is reattached, and the patient’s vision has returned to 20/25. A small residual gas bubble is still visible in this picture, and will be gone in a few days. When a gas bubble is in the eye, patients cannot fly or change elevation quickly (like going over the pass at Tahoe!).

For several years, Dr. Goldberg has taught a class with colleagues from around the world at the American Academy of Ophthalmology’s Annual Meeting.

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