A population-based analysis of long-term costs and adverse events after pneumatic retinopexy and pars plana vitrectomy

Purpose — To comprehensively examine the cost effectiveness, reattachment rate, and complications of pneumatic retinopexy (PnR) compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal healthcare system.

Design — Population-based, multicenter, consecutive, retrospective longitudinal cohort analysis.

Subjects — We identified consecutive adults aged ≥ 50 years requiring surgery for primary RRD over a 20-year interval between April 1, 2002, and March 31, 2022. Initial surgery was considered the index date for analyses.

Intervention — Pneumatic retinopexy was compared with PPV in all analyses.

Main Outcome Measures — The primary analysis investigated the mean annualized healthcare costs comparing PnR to PPV over the 2 years after initial surgery. Secondary analyses examined the primary reattachment rate and complications.

Results — In total, 25 665 eligible patients were identified, with 8794 undergoing PnR and 16 871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8924 and $11 937 after PPV (mean difference, $3,013; 95% confidence interval, $2533–$3493; P < 0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (P < 0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections, and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR.

Conclusions — Pneumatic retinopexy, when compared with PPV, was associated with lower long-term healthcare costs. Pneumatic retinopexy appeared to be effective, safe, and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases.