Three-dimensional heads-up pneumatic retinopexy with chandelier illumination for rhegmatogenous retinal detachment in eyes with mild media opacity: a prospective case series.

PURPOSE: To investigate a new technique for Pneumatic Retinopexy (PnR) using a 25G chandelier, cryotherapy, SF6 gas injection, and a heads-up 3D visualization system for rhegmatogenous retinal detachment (RRD).

METHODS

This prospective consecutive case series included 20 eyes from 20 patients with RRD including 11 macula-on and 9 macula-off cases. The surgical technique combined endoillumination via a 25-gauge chandelier with three-dimensional heads-up visualization, cryotherapy, and pure SF6 gas as an intraocular tamponade. All patients underwent a 12-month postoperative follow-up to assess primary retinal reattachment success and document any procedure-related complications.

RESULTS

The mean operative time was 10.3 ± 2.4 min. Primary anatomical success defined as single-procedure retinal reattachment without additional surgery was achieved in 80% of eyes (16/20) at 12 months. Median time to recurrence was 14 days. Of the four eyes with recurrence, two underwent a second gas injection with cryotherapy, and two required pars plana vitrectomy with silicone oil tamponade for new inferior breaks associated with proliferative vitreoretinopathy. Best-corrected visual acuity (BCVA) improved significantly from 0.54 ± 0.34 to 0.32 ± 0.23 LogMAR at 12 months postoperatively (p < 0.05).

CONCLUSION

3D heads-up PnR with chandelier illumination is a feasible technique that offers subjectively enhanced intraoperative visualization compared with indirect ophthalmoscopy, particularly in eyes with mild media opacity. Future studies should investigate differences in clinical outcomes and cost-effectiveness.