The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT)

Abstract

Purpose: The optimal surgery to repair rhegmatogenous retinal detachment (RRD) is unknown. The purpose of this trial was to compare outcomes of pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for the management of primary RRD.Design: Prospective, randomized controlled trial. Participants: Patients with RRD demonstrating a single retinal break or a group of breaks in detached retina within 1 clock hour above the 8-and 4-o'clock meridians, with any number, location and size of retinal breaks or lattice degeneration in attached retina.Methods: Patients were randomized to undergo either PnR or PPV. Macula-on and macula-off patients were assigned to intervention group by stratified randomization and were treated within 24 and 72 hours, respectively.

The Relative Impact of Patient, Physician, and Geographic Factors on Variation in Primary Rhegmatogenous Retinal Detachment Management

“…15 Cryotherapy or laser barricade typically are used in conjunction with other surgical repair procedures to barricade a retinal break and promote chorioretinal adhesion. 16 However, asymptomatic retinal breaks or small peripheral detachments may be managed by either cryotherapy or laser barricade alone. 17 Given that none of the techniques for RRD repair is superior in all respects to the alternatives, it is reasonable to expect substantial variation in use by physicians.…”

Reply

“…We read the article by Hutnik et al 1 evaluating the effectiveness of selective laser trabeculoplasty (SLT) in reducing intraocular pressure (IOP) in comparison with argon laser trabeculoplasty (ALT) for patients with medically uncontrolled open-angle glaucoma who had already undergone SLT. We want to highlight a few points that merit further discussion.…”

“…St. Josephs Healthcare London, London, Ontario, Canada TO THE EDITOR: The article by Hillier et al 1 is an interesting study that compares the outcomes of pneumatic retinopexy (PnR) with pars plana vitrectomy (PPV) for the management of primary rhegmatogenous retinal detachment (RRD). The authors report superior 1-year visual acuity and less vertical metamorphopsia with primary PnR compared with primary PPV.…”

“…The authors report superior 1-year visual acuity and less vertical metamorphopsia with primary PnR compared with primary PPV. 1 However, there are a few concerns that we would like to highlight. The PnR group required an additional gas injection in 7 eyes (8%) and repeat laser retinopexy in some eyes after the primary treatment.…”

“…The authors conclude that PnR should be considered the firstline treatment for RRD in patients fulfilling the PIVOT recruitment criteria. 1 These selection criteria are very stringent. Although there are no population-based studies reporting the percentage of RRD cases eligible for PnR, RRD following the PIVOT criteria will be a minority.…”