Air was used by Ohm and Rosengren over a half century ago for the repair of retinal detachments. Dominguez (1), and subsequently Hilton and Grizzard (2), reported the use of in-office injection of expanding gas for the repair of primary, rhegmatogenous retinal detachment. Initially, cryoretinopexy was applied before gas injection, while others used laser retinopexy after reattachment, analogous to the postreattachment retinopexy concept developed by the principal author for vitreoretinal surgery (3, 4, 5, 6, 7, 8, 9).

Retinal reattachment surgery outcome data are very difficult to interpret because of the large number of variables, vast array of surgical options, and combinations of techniques, as well as the relatively low number of cases per surgeon. Some surgeons state that pneumatic retinopexy causes proliferative vitreoretinopathy (PVR), and in spite of this, they inject gas after scleral buckling. While it is clear that pneumatic retinopexy should not be used for cases with PVR or vitreous traction, it is not known with statistical accuracy what the indications should be. It is clear that single, superior retinal breaks are the ideal cases for pneumatic retinopexy, but these cases can also be repaired with very high success rates by scleral buckling or vitrectomy, gas, and laser. Pneumatic retinopexy costs less than scleral buckling or vitrectomy-based repair. Some advocate the use of 360-degree laser retinopexy in these cases, which raises the issue of potential stimulation of PVR (10). The principal author has utilized pneumatic retinopexy in a wide variety of cases since 1988 but uses the technique less frequently in recent years because of failures due to progressive contraction of the vitreous, new retinal breaks, unpredictability, and PVR. Patients with medical problems combined with simple, superior retinal detachments are the best candidates for pneumatic retinopexy. The advent of transconjunctival, sutureless, 25-gauge vitrectomy allows many of the advantages of pneumatic retinopexy to be retained but in the context of the better outcomes afforded by vitrectomy, gas, and laser.

The authors’ current approach to pneumatic retinopexy involves avoiding cryotherapy unless an individual small tear is seen that can be treated with a single cryo spot. Avoidance of cryotherapy decreases the stimulus for PVR. If a larger tear is seen and pneumatic retinopexy is performed, injection of C₃F₈ gas without cryotherapy is the authors’ preferred course of action. If reattachment is successful, secondary laser retinopexy to the retinal tear can be performed on the attached retina. If the gas injection is unsuccessful at retinal reattachment, the authors proceed to final surgical repair with vitrectomy, and the added insult of cryo is avoided.