Baseline characteristics of rhegmatogenous retinal detachments meeting the PIVOT trial criteria in an eye referral center in Colombia: case series

Baseline characteristics of rhegmatogenous retinal detachments meeting the PIVOT trial criteria in an eye referral center in Colombia: case series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Baseline characteristics of rhegmatogenous retinal detachments meeting the PIVOT trial criteria in an eye referral center in Colombia: case series Danny Alejandra Salgado-Gómez, Jorge Eduardo Escobar, Omaira Diaz Diaz-granados, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6769128/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Introduction Rhegmatogenous retinal detachment (RRD) management continues to evolve with techniques such as scleral buckle, pars plana vitrectomy, and pneumatic retinopexy (PR). PR, a less invasive procedure, may offer advantages in resource-constrained settings. This case series aims to describe baseline characteristics and PR outcomes in patients eligible for the PIVOT trial at a Colombian tertiary center. Methods Retrospective case series study (January 2021 - April 2024) at a single center in Barranquilla, Colombia, included 143 (25.40%) of 563 consecutive RRD cases meeting PIVOT criteria (single superior break ≤ 1 clock hour in detached retina; any breaks/lattice in attached retina). Exclusion criteria included inferior breaks, media opacity, PVR ≥ B, prior detachment/PPV, age < 18, incapacity, or inability to posture. Retinal reattachment status was recorded at 3 months. The primary outcome was the single-operation success (SOS) rate of PR, defined as complete retinal reattachment at 3 months with one procedure (allowing additional gas within 21 days). Descriptive statistics, Chi-square, t-tests, and Mann-Whitney U tests were used for analysis (p value 0.05 significance). Results Of 563 RRD cases, 143 (25.4%) met PIVOT criteria. Exclusions primarily involved inferior breaks (32.6%) or PVR ≥ B (27.6%). Among 105 PIVOT-eligible patients receiving PR, SOS rate was 85.7%. Baseline factors (age, sex, lens, macular status) were similar between success (n = 90) and failure (n = 15) groups (p > 0.05). Detachments > 2 quadrants associated with failure (p = 0.045; use caution). Symptom-to-procedure time similar. Conclusion Approximately 25% of primary RRD patients met PIVOT criteria, indicating significant PR caseload potential. The high observed PR SOS rate supports its feasibility and effectiveness for appropriately selected patients in resource-constrained settings like Colombia. Rhegmatogenous Retinal Detachment Proliferative Vitreoretinopathy Pneumatic Retinopexy Case Series Treatment Outcome vitreoretinal surgery retinal surgery repair Figures Figure 1 BACKGROUND The introduction and refinement of novel surgical techniques has revolutionized the management of rhegmatogenous retinal detachments (RRDs) ( 1 ). Although, the optimal surgical technique remains controversial. Over the past decades, the management of RRD continues to evolve and includes techniques such as scleral buckle (SB), pars plana vitrectomy (PPV), pneumatic retinopexy (PR), or a combination of these ( 1 , 2 ). Pneumatic Retinopexy (PR) was first described by Dominguez in 1985 followed by Hilton and Grizzard in 1986, consisting of a non-incisional surgery involving an intravitreal injection of expandable gas with consecutive cryotherapy and/or photocoagulation of the retinal break ( 3 , 4 ). Despite the relative simplicity of PR, scleral buckling, and pars plana vitrectomy techniques have become the mainstay of surgery for RRD repair ( 1 , 2 , 5 ). Comparable anatomic and visual outcomes of each technique are leading to a paradigm shift in the vitreoretinal surgery community ( 2 , 5 , 6 ). PPV has shown a higher single-procedure anatomic reattachment than PR (93.2% vs. 80.8%, respectively; p = 0.045), hence it’s the most performed intervention for RRD in most parts of the world ( 2 , 5 ). However, PR has evidenced superior visual outcomes for primary RRD when compared to PPV (79.9 ± 10.4 letters vs. 75.0 ± 15.2 letters, respectively; p = 0.024) ( 2 ). Additionally, patients who underwent PR demonstrated 18,8% less objectively measured metamorphopsias ( 2 ). These findings could be related to a less invasive procedure leading to a high-integrity retinal reattachment that minimizes retinal vessel printing ( 7 ). It is suggested that the natural reabsorption of subretinal fluid and realignment of photoreceptors by the retinal pigment epithelium (RPE) may contribute to diminish the appearance of micropsia, aniseikonia, anisometropia, and diplopia ( 7 ). The potential cost savings of PR may have an important application in settings where resources are limited ( 5 , 8 , 9 ). SB and PPV require operating room availability and associated medical staff, whereas PR can be performed in office, offering convenience, flexibility, and expedience for the patient and the surgeon ( 8 , 9 ). Considering this trend in the management of RRD, this case series study aims to identify the characteristics of rhegmatogenous retinal detachments meeting the criteria of the PIVOT trial in a limited-resource setting with a high volume of patients. Previous publication has evidenced that there is a significant proportion (50%) of patients that meet PIVOT trial criteria ( 6 ). Preference and Trends (PAT) Survey from the American Society of Retina Specialist reveals that there is still a significant proportion of surgeons that don’t routinely perform PR, especially non-US surgeons (32.8% vs 55.8%) ( 10 ). To our knowledge, there is no previous knowledge in Latin America describing the baseline presentation of patients with RRD and the proportion of patient that meet PIVOT trial criteria. Our research shows the findings within an academic tertiary ophthalmology hospital in Barranquilla, Colombia, and we aim to bring insight on the feasibility of PR in resource-constrained environments. MATERIAL AND METHODS Study design A single center, retrospective consecutive case series study. Patients Consecutive patients with rhegmatogenous retinal detachment (RRD) admitted to a tertiary eye referral center (Clínica Oftalmológica del Caribe) in Barranquilla, Colombia, between January 2021 and April 2024 were screened. Recruitment involved a systematic search of patient records using the ICD-10 code H33 in the electronic health record system. Patients who presented RRD meeting PIVOT criteria were included in the study (a single retinal break or group of breaks, no larger than one clock hour (30 degrees), in detached retina; all breaks in detached retina to lie above the 8 and 4 o'clock meridian; breaks or lattice degeneration in attached retina at any location (even inferior). Exclusion criteria included inferior breaks in detached retina, significant media opacity (e.g., vitreous hemorrhage or cataract preventing detailed retinal examination), proliferative vitreoretinopathy (PVR) grade B or worse, previous retinal detachment (index eye), previous PPV (index eye), age < 18 years, mental incapacity, and physical inability to maintain specific posture post-operatively. The status of retinal reattachment was documented at the 3-month follow-up through physical examination by the operating surgeon. The eye was prepped with povidone-iodine under sterile conditions. Patients were positioned supine, and a blepharostat was used. Approximately 0.3 ml of aqueous humor was extracted. 100% SF6 or C3F8 gas was injected into the vitreous cavity using a 30-gauge needle inserted 3.5-4 mm posterior to the limbus, avoiding the detached retina. After injection, reflux was prevented, and central retinal artery perfusion and hand motion perception were confirmed. Proper head positioning was ensured for gas tamponade, and retinal breaks were treated with argon laser photocoagulation after 48 hours. The main outcome measures was the single operation success rate (SOS) of PR in patients meeting PIVOT criteria. SOS was defined as complete a natomical reattachment of the retina with a single procedure , including patients requiring additional gas injections within 21 days after the first procedure. Any additional gas injection beyond 21 days was considered a failure of primary treatment. Secondary outcomes included recognizing clinical factors associated with surgical success after pneumatic retinopexy and time elapsed between symptoms onset, consultation, and procedure. No patients meeting the inclusion criteria were lost to follow-up. Several strategies to mitigate potential biases were implemented. To address selection bias, consecutive incident cases were included, and clear, reproducible PIVOT eligibility criteria were applied. Regarding information bias, an electronic database and standardized diagnostic codes (ICD-10) were used, in addition to defining the variables to be collected. The main risk of confounding, especially confounding by indication when comparing treatments, was structurally addressed by focusing the primary outcome analysis on the success rate within the group that received Pneumatic Retinopexy (PR), thus avoiding direct effectiveness comparisons between non-randomly assigned procedures. The authors explicitly acknowledged the remaining limitations of the design, including treatment allocation at the surgeon's discretion. Statistical Analysis Data were analyzed using IBM SPSS Statistics for Windows, Version 29.0 (Armonk, NY: IBM Corp). Frequency tables were used for descriptive analyses. Continuous variables were assessed for normality using the Kolmogorov-Smirnov test. Normally distributed data were presented as mean ± standard deviation (SD) and compared using independent samples t-tests. Non-normally distributed data were presented as median and interquartile range (IQR) and compared using the Mann-Whitney U test. Categorical variables were presented as counts (n) and percentages (%) and compared using Chi-square tests or Fisher’s exact test where appropriate. A p-value of 0.05 was considered statistically significant. RESULTS Participants A total of 1469 cases of patients diagnosed with RRD consulted the retina department of the institution between January 2021 and April 2024. Among these, 563 cases corresponded to patients with new-onset RRD within the study period and were included for analysis. Out of the 563 cases, 143 (25.40%) met the inclusion criteria proposed by the PIVOT trial, while 420 (74.60%) did not meet the trial criteria and were excluded from follow-up (Fig. 1 ). Among the included, 105 (73,43%) were treated with PR, 16 (11.19%) received primary intervention with PPV combined with scleral buckle, 21 (14.69%) were treated solely with PPV, and 1 (0.70%) case was treated with scleral buckle. (Fig. 1 .). Single-operation success (SOS) of pneumatic retinopexy was 85,71% (90 cases), while 15 cases (14,29%) required additional pars plana vitrectomy. PVR = Proliferative vitreoretinopathy The mean age of patients was similar for the SOS and failed pneumatic retinopexy groups (57.1 and 57.8, p = 0.79, respectively). The percentage of affected males (M) and females (F) was similar for both groups (p = 0.57). Most patients' preoperative lens status was phakic (81.11%) followed by pseudophakic (17.78%) and aphakic (1.11%) (p = 0.357). 32 patients (35.56%) in the SOS group and 4 patients (26.67%) of the failed PR group presented a detached retina without macular involvement. Additionally, mild vitreous hemorrhage occurred in 6 patients (5 SOS pneumatic retinopexy; 1 failed RP). The median of days from the onset of symptoms to procedure in the SOS group (10 days, IQR: 3–30.25) was greater than that in the PR failure group (7 days, IQR: 4–24) (p = 0.812). (Table 1 ) Table 1. Baseline characteristics of the 91 eyes meeting PIVOT trial criteria that underwent pneumatic retinopexy. Following PR, most cases (95.24%) required laser retinopexy, and 15.24% of patients needed additional gas injection, while only 2.86% received cryopexy. (Table 2 ). Table 2 Details of patients with rhegmatogenous retinal detachments who met PIVOT criteria and were treated by pneumatic retinopexy. Variable n (%) n = 105 Patients requiring preoperative laser treatment 1 (0.95) Cryopexy 3 (2.86) Patients requiring postoperative laser retinopexy 100 (95.24) Patients requiring additional gas injection* 16 (15.24) * Number of patients requiring additional gas injections within 21 days after the operative procedure. Any additional gas injection beyond 21 days was considered a failure of primary treatment. DISCUSSION Our study’s main findings evidenced that 25.4% of patients (1 in 4) presenting in an eye referral center with RRD meet PIVOT trial criteria and can be candidates for PR as a first-line treatment. While PPV is associated with a higher rate of primary reattachment, PR offers patients advantages such as a less invasive procedure, minimal retinal displacement, improved visual function, prevention of refractive changes, reduced cataract formation, and shorter recovery times ( 2 , 5 , 8 , 11 ). More importantly, for healthcare providers, PR is accessible at a lower cost, benefiting countries with limited resources ( 8 , 9 ). Through this study, we found a SOS for PR of 85.71%. These findings are comparable to the results of a meta-analysis that included 4,138 eyes among 81 reports from world literature where the average SOS was 74.4% ( 12 ). Additionally, Yannuzzi et al reported a SOS rate of 68.5% in 9659 eyes treated with PR for primary RRD ( 13 ). Although higher SOS rates for PR have been reported (82%), a multi-center study that evaluated the single-procedure anatomic success of PR performed by vitreoretinal fellows in 483 patients evidenced a SOS of 67% ( 14 ). Remarkably, PR demonstrated better anatomic outcomes, with greater single-procedure success after performing 15 cases (86.2% SOS for > 15 cases vs. 60.0-63.2% SOS for ≤ 15 cases) ( 14 ). Patient’s preoperative lens status was not found statistically significant in this study. Although, previous studies have shown a lower success rate of RP in pseudophakic or aphakic eyes compared with phakic eyes ( 15 , 16 ). Rootman et al. identified the morphologic characteristics that could predict failure of pneumatic retinopexy finding pseudophakic status (p < 0.05, odds ratio (OR) 2.9; 95% CI, 1.06–7.88), presence of retinal breakage greater than 1 clock hour and PVR grade C or D ( 15 ). The condition of the lens may influence the visualization of retinal tears and potentially benefit postoperative laser retinopexy ( 15 ). The lower success rate in pseudophakic eyes may be attributed to misplaced tears, tears in the far periphery that may go unnoticed because of impaired posterior pole vision due to capsular opacification, intraocular lens-related reflexes, poor mydriasis, or failure due to forward migration of the gas bubble ( 17 , 18 ). Furthermore, McAllister et al described that pseudophakic eyes with posterior capsule rupture had worse outcomes after PR than those with an integral posterior capsule. ( 19 ). A single operation success for patients with retinal detachment > 2 quadrants was evidenced, although some case series have reported lower success rates associated with extensive retinal detachments ( 20 , 21 ). It is noteworthy that the distribution of our variables included only 2 quadrants as a cutoff point, while other reports report worse prognosis in detachments greater than 4 quadrants ( 20 , 21 ). It is important to highlight the characteristics of patients who are not candidates for PR as a first-line treatment to minimize undesired outcomes and the need for reinterventions. The most prevalent characteristic for patients presenting with RRD that did not meet the PIVOT trial criteria were the presence of tears in the lower retina and an advanced degree of PVR, the latter being a primary cause of surgery failure ( 22 , 23 ). The presence of PVR has been associated with factors such as chronic retinal detachment, aggressive retinitis, vitreous hemorrhage, aphakia, choroidal detachment, high levels of vitreous protein, giant retinal tears, or inflammation history ( 23 ). Its development leads to traction of the retina and recurrent retinal detachment. Under this premise, the preoperative evaluation of these cases is crucial for the appropriate selection of a treatment plan ( 23 ). The time elapsed from the onset of symptoms and initial consultation to procedure did not reveal notable differences for successful PR compared to unsuccessful ones. However, the median time from consult to surgery was very short in this study (SOS: 0 days, PR Failure: 0 day). This could suggest that time plays an important role in in PR, where further research is needed to determine if early treatment could yield superior anatomical outcomes. This holds relevance in developing regions and settings with scarce resources, where PR emerges as a highly viable therapeutic option. PR is a desirable treatment option with outcomes comparable to those of PPV requiring substantially fewer resources ( 2 , 9 ). We acknowledge the inherent limitations of our study, including its retrospective nature and data collection from secondary sources. This methodology also limits the ability to establish causality. It is important to note that sampling was convenience-based according to the availability of records in databases, potentially leading to selection and information bias. The reliance on data from electronic medical records may introduce inaccuracies or missing information. Additionally, the lack of a comparative group undergoing alternative treatments limits the ability to draw definitive conclusions about the efficacy of this intervention. Moreover, there was no standardized protocol for the intervention as it was at the discretion of the surgeon performing initial evaluation. On the other hand, its strength lies in its population base, which, despite the fact that data was extracted from a single center in Barranquilla, this reference center covers all socioeconomic strata and provides the greatest coverage in ophthalmology on the Colombian Caribbean coast, allowing a comprehensive vision of our reality and understanding of the clinical characteristics of these patients. Its robust methodology, employing a well-defined study population and clear inclusion and exclusion criteria, the inclusion of demographic, clinical, and clinical evolution variables provided a detailed understanding of the characteristics of RRDs in the study setting. Nevertheless, the findings provide insights into our reality, allowing for a comprehensive understanding of the clinical characteristics of these patients. CONCLUSION These findings highlight the complexity and severity of retinal detachments in the population studied, understanding the behavior of RRDs in Colombia serves as a valuable tool for directing healthcare policies, improving patient care, and offering proven first-line treatments with favorable outcomes. This comprehensive study sheds light on the nuanced aspects of RRD within the Colombian population, providing information in a highly relevant subject in ophthalmology. Abbreviations C3F8: Octafluoropropane IQR: interquartile range PIVOT: Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment. PPV: Pars plana vitrectomy PR: pneumatic retinopexy PVR: Proliferative Vitreoretinopathy RRD: Rhegmatogenous retinal detachment SF6: Sulfur hexafluoride SOS: Single operation success SD: standard deviation Declarations Ethics approval and consent to participate The institutional review board and ethics committee of La Clínica Oftalmológica del Caribe, Barranquilla, Colombia, approved this study and consent was not required given the retrospective nature of the study. (Record 102, January 26, 2024). Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no financial support for the research, authorship or publication of this article. Authors' contributions JC reviewed the literature and offered expertise in the study's methods. DS and JE handled data collection. LE and OD analyzed the findings and prepared the manuscript for journal publication. All authors read and approved the final manuscript. Acknowledgements Not applicable Authors' information (optional) Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. References Felfeli T, Rajeev HM, Hiller RJ. The Evolution of Retinal Detachment Surgery Outcomes: Putting ‘PIVOT’ Into Perspective. J VitreoRetinal Dis. 2019;12(3):363–5. Hillier RJ, Felfeli T, Berger AR, Wong DT, Altomare F, Dai D et al. The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT). Ophthalmology. 2019;126(4):531–539. 10.1016/j.ophtha.2018.11.014PubMedGoogle Scholar. Domínguez A. Cirugía precoz y ambulatoria del desprendimiento de retina. Arch Soc Esp Ofta. 1985;48:47–54. Hilton GF, Grizzard WS. Pneumatic retinopexy: a two-step outpatient operation without conjunctival incision. Ophthalmology. 1986;93:626–41. Tornambe PE, Hilton GF, Poliner LS, Brinton DA, Flood TP, Orth DH, Packo KH, Green S, Leff SR, Masciulli L, Yarian DL, Grizzard WS, Hammer ME, Taren DL, Morgan CM, Tiedeman JS. Pneumatic Retinopexy: A Multicenter Randomized Controlled Clinical Trial Comparing Pneumatic Retinopexy with Scleral Buckling. Ophthalmology. 1989;96(6):772–84. https://doi.org/10.1016/S0161-6420(89)32820-X . Juncal VR, Bamakrid M, Jin S, Paracha Q, Ta Kim DT, Marafon SB, Francisconi CLM. Pneumatic Retinopexy in Patients with Primary Rhegmatogenous Retinal Detachment Meeting PIVOT Trial Criteria. Ophthalmol Retina. 2021;5(3):262–9. Brosh K, Francisconi CLM, Qian J, et al. Retinal displacement following pneumatic retinopexy vs pars plana vitrectomy for rhegmatogenous retinal detachment. JAMA Ophthalmol. 2020;138:652–9. Jung JJ, Cheng J, Pan JY, Brinton DA, Hoang QV. Anatomic, visual, and financial outcomes for traditional and nontraditional primary pneumatic retinopexy for retinal detachment. Am J Ophthalmol. 2019;200:187–200. 10.1016/j.ajo.2019.01.008 . Elhusseiny AM, Yannuzzi NA, Smiddy WE. Cost Analysis of Pneumatic Retinopexy versus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment. Ophthalmol Retina. 2019;3(11):956–61. https://doi.org/10.1016/j.oret.2019.06.003 . Hahn P, Garg SJ et al. 2023 Global Trends in Retina Survey: Chicago, IL. American Society of Retina Specialists; 2023. Roshanshad A, Shirzadi S, Binder S, Arevalo JF. Pneumatic Retinopexy Versus Pars Plana Vitrectomy for the Management of Retinal Detachment: A Systematic Review and Meta-Analysis. Ophthalmol Ther. 2023;12(2):705–19. 10.1007/s40123-023-00653-9 . Chan CK, Lin SG, Nuthi AS, Salib DM. Pneumatic Retinopexy for the Repair of Retinal Detachments: A Comprehensive Review (1986–2007). Surv Ophthalmol. 2019;53(5):443478. 10.1016/j.survophthal.2008.06.008 10.1016/j.survophthal.2008.06.008 . Yannuzzi NA, Li C, Fujino D, et al. Clinical Outcomes of Rhegmatogenous Retinal Detachment Treated With Pneumatic Retinopexy. JAMA Ophthalmol. 2021;139(8):848–53. 10.1001/jamaophthalmol.2021.1860 . Emami-Naeini P, Deaner J, Ali F, Gogte P, et al. Pneumatic Retinopexy Experience and Outcomes of Vitreoretinal Fellows in the United States: A Multicenter Study. Ophthalmol Retina. 2019;3(2):140–5. https://doi.org/10.1016/j.oret.2018.09.010 . Rootman DB, Luu SM, Conti S, Mandell M, Devenyi R, Lam WC, Kertes PJ. Predictors of treatment failure for pneumatic retinopexy. Can J Ophthalmol. 2013;48(6):549–52. https://doi.org/10.1016/j.jcjo.2013.05.002 . Dhami A, Shah KK, Ratra D. Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment. Indian J Ophthalmol. 2018;66(3):420–5. 10.4103/ijo.IJO_999_17 . Dhami A, Shah KK, Ratra D. Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment. Indian J Ophthalmol. 2018;66(3):420–5. 10.4103/ijo.IJO_999_17 . Lois N, Wong D. Pseudophakic retinal detachment. Surv Ophthalmol. 2003;48(5):467–87. 10.1016/s0039-6257(03)00083-3) . McAllister IL, Meyers SM, Zegarra H, et al. Comparison of pneumatic retinopexy with alternative surgical techniques. Volume 95. Ophthalmology; 1988. pp. 877–83. Grizzard WS, Hilton GF, Hammer ME, Taren D, Brinton DA. Pneumatic Retinopexy Failures Ophthalmol. 1995;102(6):929–36. Davis MJ, Mudvari SS, Shott S, Rezaei KA. Características clínicas que afectan el resultado de la retinopexia neumática. Arco Oftalmol. 2011;129(2):163–6. Kwon OW, Song JH, Roh MI. Retinal Detachment and Proliferative Vitreoretinopathy. Dev Ophthalmol. 2016;55:154–62. https://doi.org/10.1159/000438972 . Idrees S, Sridhar J, Kuriyan AE. Proliferative Vitreoretinopathy: A Review. Int Ophthalmol Clin. 2019;59(1):221–40. 10.1097/IIO.0000000000000258 . Tables Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 15 Jul, 2025 Reviews received at journal 14 Jul, 2025 Reviewers agreed at journal 30 Jun, 2025 Reviews received at journal 23 Jun, 2025 Reviewers agreed at journal 16 Jun, 2025 Reviewers invited by journal 03 Jun, 2025 Editor assigned by journal 02 Jun, 2025 Submission checks completed at journal 30 May, 2025 First submitted to journal 28 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6769128","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":465813504,"identity":"cef69611-86c9-4e3c-a180-16fb5e627248","order_by":0,"name":"Danny Alejandra Salgado-Gómez","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYDCCAxBKBogNGBIqbIA0Y+MBYrTwgLV8OJMG0tJAvBbGmW2HkQWxA77jZ4895vljxyPvfnjjYx6283Zr2w8DbamxicalRfJMXroxb1syj+GZtGJjHp7bydvOJAK1HEvLbcChxeBAjpk0bwMzj2EDkMEjcTvZ7ABQC2PDYdxazr8BqvxTz2PYD2IYnEs2O/+QgJYbIMPZDvPIS+SYSc5IOGBndoOALZI33phJzm07zmMg8azY4MOB5ASzG0BbEvD4he98jpnEmz/VcvL9yRsfJP6zszc7n/7wwYcaG5xaQIAJHCkHIJxEsMoEPMpBgPEHkJCHGmpPQPEoGAWjYBSMQAAAXvJlCRjXuCcAAAAASUVORK5CYII=","orcid":"","institution":"Clínica Oftalmológica del Caribe","correspondingAuthor":true,"prefix":"","firstName":"Danny","middleName":"Alejandra","lastName":"Salgado-Gómez","suffix":""},{"id":465813505,"identity":"234b191f-c7ff-4f75-8c44-e3b1c73f0530","order_by":1,"name":"Jorge Eduardo Escobar","email":"","orcid":"","institution":"Clínica Oftalmológica del Caribe","correspondingAuthor":false,"prefix":"","firstName":"Jorge","middleName":"Eduardo","lastName":"Escobar","suffix":""},{"id":465813506,"identity":"492606ac-f894-432a-b979-0edd6447e170","order_by":2,"name":"Omaira Diaz Diaz-granados","email":"","orcid":"","institution":"Clínica Oftalmológica del Caribe","correspondingAuthor":false,"prefix":"","firstName":"Omaira","middleName":"Diaz","lastName":"Diaz-granados","suffix":""},{"id":465813507,"identity":"a4479524-1b87-4df6-8ce8-4af53e314897","order_by":3,"name":"Luis Carlos Escaf","email":"","orcid":"","institution":"Clínica Oftalmológica del Caribe","correspondingAuthor":false,"prefix":"","firstName":"Luis","middleName":"Carlos","lastName":"Escaf","suffix":""}],"badges":[],"createdAt":"2025-05-28 14:38:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6769128/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6769128/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84212465,"identity":"2b439dcd-eb15-4383-919f-7992cde2af79","added_by":"auto","created_at":"2025-06-09 10:19:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37291,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram representing the distribution of rhegmatogenous retinal detachments (RRD) that met the PIVOT criteria\u003c/p\u003e\n\u003cp\u003ePVR = Proliferative vitreoretinopathy\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6769128/v1/00ad8092043fa9fa6b92c087.png"},{"id":84212467,"identity":"30ad6c91-c83f-4f5e-8dd3-035613dd36e3","added_by":"auto","created_at":"2025-06-09 10:19:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":577089,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6769128/v1/388f0e4b-4959-4f75-893c-6ddd0568c330.pdf"},{"id":84212463,"identity":"c7dfabd8-0f2e-4a40-b6b3-bb3f8f1beb01","added_by":"auto","created_at":"2025-06-09 10:19:14","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16669,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6769128/v1/ba0f0d7f570bd88cdf9f59b1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Baseline characteristics of rhegmatogenous retinal detachments meeting the PIVOT trial criteria in an eye referral center in Colombia: case series","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThe introduction and refinement of novel surgical techniques has revolutionized the management of rhegmatogenous retinal detachments (RRDs) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although, the optimal surgical technique remains controversial. Over the past decades, the management of RRD continues to evolve and includes techniques such as scleral buckle (SB), pars plana vitrectomy (PPV), pneumatic retinopexy (PR), or a combination of these (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePneumatic Retinopexy (PR) was first described by Dominguez in 1985 followed by Hilton and Grizzard in 1986, consisting of a non-incisional surgery involving an intravitreal injection of expandable gas with consecutive cryotherapy and/or photocoagulation of the retinal break (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Despite the relative simplicity of PR, scleral buckling, and pars plana vitrectomy techniques have become the mainstay of surgery for RRD repair (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComparable anatomic and visual outcomes of each technique are leading to a paradigm shift in the vitreoretinal surgery community (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). PPV has shown a higher single-procedure anatomic reattachment than PR (93.2% vs. 80.8%, respectively; p\u0026thinsp;=\u0026thinsp;0.045), hence it\u0026rsquo;s the most performed intervention for RRD in most parts of the world (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, PR has evidenced superior visual outcomes for primary RRD when compared to PPV (79.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 letters vs. 75.0\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2 letters, respectively; p\u0026thinsp;=\u0026thinsp;0.024) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Additionally, patients who underwent PR demonstrated 18,8% less objectively measured metamorphopsias (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). These findings could be related to a less invasive procedure leading to a high-integrity retinal reattachment that minimizes retinal vessel printing (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). It is suggested that the natural reabsorption of subretinal fluid and realignment of photoreceptors by the retinal pigment epithelium (RPE) may contribute to diminish the appearance of micropsia, aniseikonia, anisometropia, and diplopia (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe potential cost savings of PR may have an important application in settings where resources are limited (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). SB and PPV require operating room availability and associated medical staff, whereas PR can be performed in office, offering convenience, flexibility, and expedience for the patient and the surgeon (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsidering this trend in the management of RRD, this case series study aims to identify the characteristics of rhegmatogenous retinal detachments meeting the criteria of the PIVOT trial in a limited-resource setting with a high volume of patients. Previous publication has evidenced that there is a significant proportion (50%) of patients that meet PIVOT trial criteria (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Preference and Trends (PAT) Survey from the American Society of Retina Specialist reveals that there is still a significant proportion of surgeons that don\u0026rsquo;t routinely perform PR, especially non-US surgeons (32.8% vs 55.8%) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). To our knowledge, there is no previous knowledge in Latin America describing the baseline presentation of patients with RRD and the proportion of patient that meet PIVOT trial criteria. Our research shows the findings within an academic tertiary ophthalmology hospital in Barranquilla, Colombia, and we aim to bring insight on the feasibility of PR in resource-constrained environments.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA single center, retrospective consecutive case series study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatients\u003c/h3\u003e\n\u003cp\u003eConsecutive patients with rhegmatogenous retinal detachment (RRD) admitted to a tertiary eye referral center (Cl\u0026iacute;nica Oftalmol\u0026oacute;gica del Caribe) in Barranquilla, Colombia, between January 2021 and April 2024 were screened. Recruitment involved a systematic search of patient records using the ICD-10 code H33 in the electronic health record system. Patients who presented RRD meeting PIVOT criteria were included in the study (a single retinal break or group of breaks, no larger than one clock hour (30 degrees), in detached retina; all breaks in detached retina to lie above the 8 and 4 o'clock meridian; breaks or lattice degeneration in attached retina at any location (even inferior). Exclusion criteria included inferior breaks in detached retina, significant media opacity (e.g., vitreous hemorrhage or cataract preventing detailed retinal examination), proliferative vitreoretinopathy (PVR) grade B or worse, previous retinal detachment (index eye), previous PPV (index eye), age\u0026thinsp;\u0026lt;\u0026thinsp;18 years, mental incapacity, and physical inability to maintain specific posture post-operatively. The status of retinal reattachment was documented at the 3-month follow-up through physical examination by the operating surgeon.\u003c/p\u003e \u003cp\u003eThe eye was prepped with povidone-iodine under sterile conditions. Patients were positioned supine, and a blepharostat was used. Approximately 0.3 ml of aqueous humor was extracted. 100% SF6 or C3F8 gas was injected into the vitreous cavity using a 30-gauge needle inserted 3.5-4 mm posterior to the limbus, avoiding the detached retina. After injection, reflux was prevented, and central retinal artery perfusion and hand motion perception were confirmed. Proper head positioning was ensured for gas tamponade, and retinal breaks were treated with argon laser photocoagulation after 48 hours.\u003c/p\u003e \u003cp\u003eThe main outcome measures was the single operation success rate (SOS) of PR in patients meeting PIVOT criteria. SOS was defined as complete a\u003cb\u003enatomical reattachment of the retina with a single procedure\u003c/b\u003e, including patients requiring additional gas injections within 21 days after the first procedure. Any additional gas injection beyond 21 days was considered a failure of primary treatment. Secondary outcomes included recognizing clinical factors associated with surgical success after pneumatic retinopexy and time elapsed between symptoms onset, consultation, and procedure. No patients meeting the inclusion criteria were lost to follow-up.\u003c/p\u003e \u003cp\u003eSeveral strategies to mitigate potential biases were implemented. To address selection bias, consecutive incident cases were included, and clear, reproducible PIVOT eligibility criteria were applied. Regarding information bias, an electronic database and standardized diagnostic codes (ICD-10) were used, in addition to defining the variables to be collected. The main risk of confounding, especially confounding by indication when comparing treatments, was structurally addressed by focusing the primary outcome analysis on the success rate within the group that received Pneumatic Retinopexy (PR), thus avoiding direct effectiveness comparisons between non-randomly assigned procedures. The authors explicitly acknowledged the remaining limitations of the design, including treatment allocation at the surgeon's discretion.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS Statistics for Windows, Version 29.0 (Armonk, NY: IBM Corp). Frequency tables were used for descriptive analyses. Continuous variables were assessed for normality using the Kolmogorov-Smirnov test. Normally distributed data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and compared using independent samples t-tests. Non-normally distributed data were presented as median and interquartile range (IQR) and compared using the Mann-Whitney U test. Categorical variables were presented as counts (n) and percentages (%) and compared using Chi-square tests or Fisher\u0026rsquo;s exact test where appropriate. A p-value of 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eA total of 1469 cases of patients diagnosed with RRD consulted the retina department of the institution between January 2021 and April 2024. Among these, 563 cases corresponded to patients with new-onset RRD within the study period and were included for analysis.\u003c/p\u003e \u003cp\u003eOut of the 563 cases, 143 (25.40%) met the inclusion criteria proposed by the PIVOT trial, while 420 (74.60%) did not meet the trial criteria and were excluded from follow-up (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among the included, 105 (73,43%) were treated with PR, 16 (11.19%) received primary intervention with PPV combined with scleral buckle, 21 (14.69%) were treated solely with PPV, and 1 (0.70%) case was treated with scleral buckle. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.). Single-operation success (SOS) of pneumatic retinopexy was 85,71% (90 cases), while 15 cases (14,29%) required additional pars plana vitrectomy.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePVR\u0026thinsp;=\u0026thinsp;Proliferative vitreoretinopathy\u003c/p\u003e \u003cp\u003eThe mean age of patients was similar for the SOS and failed pneumatic retinopexy groups (57.1 and 57.8, p\u0026thinsp;=\u0026thinsp;0.79, respectively). The percentage of affected males (M) and females (F) was similar for both groups (p\u0026thinsp;=\u0026thinsp;0.57). Most patients' preoperative lens status was phakic (81.11%) followed by pseudophakic (17.78%) and aphakic (1.11%) (p\u0026thinsp;=\u0026thinsp;0.357). 32 patients (35.56%) in the SOS group and 4 patients (26.67%) of the failed PR group presented a detached retina without macular involvement. Additionally, mild vitreous hemorrhage occurred in 6 patients (5 SOS pneumatic retinopexy; 1 failed RP). The median of days from the onset of symptoms to procedure in the SOS group (10 days, IQR: 3\u0026ndash;30.25) was greater than that in the PR failure group (7 days, IQR: 4\u0026ndash;24) (p\u0026thinsp;=\u0026thinsp;0.812). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Baseline characteristics of the 91 eyes meeting PIVOT trial criteria that underwent pneumatic retinopexy.\u003c/p\u003e\n\u003cp\u003eFollowing PR, most cases (95.24%) required laser retinopexy, and 15.24% of patients needed additional gas injection, while only 2.86% received cryopexy. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetails of patients with rhegmatogenous retinal detachments who met PIVOT criteria and were treated by pneumatic retinopexy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;105\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients requiring preoperative laser treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCryopexy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients requiring postoperative laser retinopexy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100 (95.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients requiring additional gas injection*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (15.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e*\u003c/b\u003eNumber of patients requiring additional gas injections within 21 days after the operative procedure. Any additional gas injection beyond 21 days was considered a failure of primary treatment.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study\u0026rsquo;s main findings evidenced that 25.4% of patients (1 in 4) presenting in an eye referral center with RRD meet PIVOT trial criteria and can be candidates for PR as a first-line treatment. While PPV is associated with a higher rate of primary reattachment, PR offers patients advantages such as a less invasive procedure, minimal retinal displacement, improved visual function, prevention of refractive changes, reduced cataract formation, and shorter recovery times (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). More importantly, for healthcare providers, PR is accessible at a lower cost, benefiting countries with limited resources (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThrough this study, we found a SOS for PR of 85.71%. These findings are comparable to the results of a meta-analysis that included 4,138 eyes among 81 reports from world literature where the average SOS was 74.4% (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Additionally, Yannuzzi et al reported a SOS rate of 68.5% in 9659 eyes treated with PR for primary RRD (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough higher SOS rates for PR have been reported (82%), a multi-center study that evaluated the single-procedure anatomic success of PR performed by vitreoretinal fellows in 483 patients evidenced a SOS of 67% (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Remarkably, PR demonstrated better anatomic outcomes, with greater single-procedure success after performing 15 cases (86.2% SOS for \u0026gt;\u0026thinsp;15 cases vs. 60.0-63.2% SOS for \u0026le;\u0026thinsp;15 cases) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePatient\u0026rsquo;s preoperative lens status was not found statistically significant in this study. Although, previous studies have shown a lower success rate of RP in pseudophakic or aphakic eyes compared with phakic eyes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Rootman et al. identified the morphologic characteristics that could predict failure of pneumatic retinopexy finding pseudophakic status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, odds ratio (OR) 2.9; 95% CI, 1.06\u0026ndash;7.88), presence of retinal breakage greater than 1 clock hour and PVR grade C or D (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe condition of the lens may influence the visualization of retinal tears and potentially benefit postoperative laser retinopexy (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The lower success rate in pseudophakic eyes may be attributed to misplaced tears, tears in the far periphery that may go unnoticed because of impaired posterior pole vision due to capsular opacification, intraocular lens-related reflexes, poor mydriasis, or failure due to forward migration of the gas bubble (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Furthermore, McAllister et al described that pseudophakic eyes with posterior capsule rupture had worse outcomes after PR than those with an integral posterior capsule. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA single operation success for patients with retinal detachment\u0026thinsp;\u0026gt;\u0026thinsp;2 quadrants was evidenced, although some case series have reported lower success rates associated with extensive retinal detachments (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). It is noteworthy that the distribution of our variables included only 2 quadrants as a cutoff point, while other reports report worse prognosis in detachments greater than 4 quadrants (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is important to highlight the characteristics of patients who are not candidates for PR as a first-line treatment to minimize undesired outcomes and the need for reinterventions. The most prevalent characteristic for patients presenting with RRD that did not meet the PIVOT trial criteria were the presence of tears in the lower retina and an advanced degree of PVR, the latter being a primary cause of surgery failure (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe presence of PVR has been associated with factors such as chronic retinal detachment, aggressive retinitis, vitreous hemorrhage, aphakia, choroidal detachment, high levels of vitreous protein, giant retinal tears, or inflammation history (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Its development leads to traction of the retina and recurrent retinal detachment. Under this premise, the preoperative evaluation of these cases is crucial for the appropriate selection of a treatment plan (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe time elapsed from the onset of symptoms and initial consultation to procedure did not reveal notable differences for successful PR compared to unsuccessful ones. However, the median time from consult to surgery was very short in this study (SOS: 0 days, PR Failure: 0 day). This could suggest that time plays an important role in in PR, where further research is needed to determine if early treatment could yield superior anatomical outcomes. This holds relevance in developing regions and settings with scarce resources, where PR emerges as a highly viable therapeutic option. PR is a desirable treatment option with outcomes comparable to those of PPV requiring substantially fewer resources (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe acknowledge the inherent limitations of our study, including its retrospective nature and data collection from secondary sources. This methodology also limits the ability to establish causality. It is important to note that sampling was convenience-based according to the availability of records in databases, potentially leading to selection and information bias. The reliance on data from electronic medical records may introduce inaccuracies or missing information. Additionally, the lack of a comparative group undergoing alternative treatments limits the ability to draw definitive conclusions about the efficacy of this intervention. Moreover, there was no standardized protocol for the intervention as it was at the discretion of the surgeon performing initial evaluation. On the other hand, its strength lies in its population base, which, despite the fact that data was extracted from a single center in Barranquilla, this reference center covers all socioeconomic strata and provides the greatest coverage in ophthalmology on the Colombian Caribbean coast, allowing a comprehensive vision of our reality and understanding of the clinical characteristics of these patients. Its robust methodology, employing a well-defined study population and clear inclusion and exclusion criteria, the inclusion of demographic, clinical, and clinical evolution variables provided a detailed understanding of the characteristics of RRDs in the study setting. Nevertheless, the findings provide insights into our reality, allowing for a comprehensive understanding of the clinical characteristics of these patients.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThese findings highlight the complexity and severity of retinal detachments in the population studied, understanding the behavior of RRDs in Colombia serves as a valuable tool for directing healthcare policies, improving patient care, and offering proven first-line treatments with favorable outcomes. This comprehensive study sheds light on the nuanced aspects of RRD within the Colombian population, providing information in a highly relevant subject in ophthalmology.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eC3F8: Octafluoropropane\u003c/p\u003e\n\u003cp\u003eIQR: interquartile range\u003c/p\u003e\n\u003cp\u003ePIVOT: Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment.\u003c/p\u003e\n\u003cp\u003ePPV: Pars plana vitrectomy\u003c/p\u003e\n\u003cp\u003ePR: pneumatic retinopexy\u003c/p\u003e\n\u003cp\u003ePVR: Proliferative Vitreoretinopathy\u003c/p\u003e\n\u003cp\u003eRRD: Rhegmatogenous retinal detachment\u003c/p\u003e\n\u003cp\u003eSF6: Sulfur hexafluoride\u003c/p\u003e\n\u003cp\u003eSOS: Single operation success\u003c/p\u003e\n\u003cp\u003eSD: standard deviation\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe institutional review board and ethics committee of La Cl\u0026iacute;nica Oftalmol\u0026oacute;gica del Caribe, Barranquilla, Colombia, approved this study and consent was not required given the retrospective nature of the study. (Record 102, January 26, 2024).\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship or publication of this article.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n\u003cp\u003eJC reviewed the literature and offered expertise in the study\u0026apos;s methods. DS and JE handled data collection. LE and OD analyzed the findings and prepared the manuscript for journal publication. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information (optional)\u003c/p\u003e\n\u003ch2\u003eDeclaration of Conflicting Interests:\u003c/h2\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFelfeli T, Rajeev HM, Hiller RJ. The Evolution of Retinal Detachment Surgery Outcomes: Putting \u0026lsquo;PIVOT\u0026rsquo; Into Perspective. J VitreoRetinal Dis. 2019;12(3):363\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHillier RJ, Felfeli T, Berger AR, Wong DT, Altomare F, Dai D et al. The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT). Ophthalmology. 2019;126(4):531\u0026ndash;539. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ophtha.2018.11.014PubMedGoogle\u003c/span\u003e\u003cspan address=\"10.1016/j.ophtha.2018.11.014PubMedGoogle\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Scholar.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDom\u0026iacute;nguez A. Cirug\u0026iacute;a precoz y ambulatoria del desprendimiento de retina. Arch Soc Esp Ofta. 1985;48:47\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHilton GF, Grizzard WS. Pneumatic retinopexy: a two-step outpatient operation without conjunctival incision. Ophthalmology. 1986;93:626\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTornambe PE, Hilton GF, Poliner LS, Brinton DA, Flood TP, Orth DH, Packo KH, Green S, Leff SR, Masciulli L, Yarian DL, Grizzard WS, Hammer ME, Taren DL, Morgan CM, Tiedeman JS. Pneumatic Retinopexy: A Multicenter Randomized Controlled Clinical Trial Comparing Pneumatic Retinopexy with Scleral Buckling. Ophthalmology. 1989;96(6):772\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0161-6420(89)32820-X\u003c/span\u003e\u003cspan address=\"10.1016/S0161-6420(89)32820-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJuncal VR, Bamakrid M, Jin S, Paracha Q, Ta Kim DT, Marafon SB, Francisconi CLM. Pneumatic Retinopexy in Patients with Primary Rhegmatogenous Retinal Detachment Meeting PIVOT Trial Criteria. Ophthalmol Retina. 2021;5(3):262\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrosh K, Francisconi CLM, Qian J, et al. Retinal displacement following pneumatic retinopexy vs pars plana vitrectomy for rhegmatogenous retinal detachment. JAMA Ophthalmol. 2020;138:652\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJung JJ, Cheng J, Pan JY, Brinton DA, Hoang QV. Anatomic, visual, and financial outcomes for traditional and nontraditional primary pneumatic retinopexy for retinal detachment. Am J Ophthalmol. 2019;200:187\u0026ndash;200. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajo.2019.01.008\u003c/span\u003e\u003cspan address=\"10.1016/j.ajo.2019.01.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElhusseiny AM, Yannuzzi NA, Smiddy WE. Cost Analysis of Pneumatic Retinopexy versus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment. Ophthalmol Retina. 2019;3(11):956\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.oret.2019.06.003\u003c/span\u003e\u003cspan address=\"10.1016/j.oret.2019.06.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHahn P, Garg SJ et al. 2023 Global Trends in Retina Survey: Chicago, IL. American Society of Retina Specialists; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoshanshad A, Shirzadi S, Binder S, Arevalo JF. Pneumatic Retinopexy Versus Pars Plana Vitrectomy for the Management of Retinal Detachment: A Systematic Review and Meta-Analysis. Ophthalmol Ther. 2023;12(2):705\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40123-023-00653-9\u003c/span\u003e\u003cspan address=\"10.1007/s40123-023-00653-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan CK, Lin SG, Nuthi AS, Salib DM. Pneumatic Retinopexy for the Repair of Retinal Detachments: A Comprehensive Review (1986\u0026ndash;2007). Surv Ophthalmol. 2019;53(5):443478. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.survophthal.2008.06.008 10.1016/j.survophthal.2008.06.008\u003c/span\u003e\u003cspan address=\"10.1016/j.survophthal.2008.06.008 10.1016/j.survophthal.2008.06.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYannuzzi NA, Li C, Fujino D, et al. Clinical Outcomes of Rhegmatogenous Retinal Detachment Treated With Pneumatic Retinopexy. JAMA Ophthalmol. 2021;139(8):848\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamaophthalmol.2021.1860\u003c/span\u003e\u003cspan address=\"10.1001/jamaophthalmol.2021.1860\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmami-Naeini P, Deaner J, Ali F, Gogte P, et al. Pneumatic Retinopexy Experience and Outcomes of Vitreoretinal Fellows in the United States: A Multicenter Study. Ophthalmol Retina. 2019;3(2):140\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.oret.2018.09.010\u003c/span\u003e\u003cspan address=\"10.1016/j.oret.2018.09.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRootman DB, Luu SM, Conti S, Mandell M, Devenyi R, Lam WC, Kertes PJ. Predictors of treatment failure for pneumatic retinopexy. Can J Ophthalmol. 2013;48(6):549\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jcjo.2013.05.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jcjo.2013.05.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhami A, Shah KK, Ratra D. Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment. Indian J Ophthalmol. 2018;66(3):420\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijo.IJO_999_17\u003c/span\u003e\u003cspan address=\"10.4103/ijo.IJO_999_17\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhami A, Shah KK, Ratra D. Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment. Indian J Ophthalmol. 2018;66(3):420\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijo.IJO_999_17\u003c/span\u003e\u003cspan address=\"10.4103/ijo.IJO_999_17\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLois N, Wong D. Pseudophakic retinal detachment. Surv Ophthalmol. 2003;48(5):467\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0039-6257(03)00083-3)\u003c/span\u003e\u003cspan address=\"10.1016/s0039-6257(03)00083-3)\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcAllister IL, Meyers SM, Zegarra H, et al. Comparison of pneumatic retinopexy with alternative surgical techniques. Volume 95. Ophthalmology; 1988. pp. 877\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrizzard WS, Hilton GF, Hammer ME, Taren D, Brinton DA. Pneumatic Retinopexy Failures Ophthalmol. 1995;102(6):929\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis MJ, Mudvari SS, Shott S, Rezaei KA. Caracter\u0026iacute;sticas cl\u0026iacute;nicas que afectan el resultado de la retinopexia neum\u0026aacute;tica. Arco Oftalmol. 2011;129(2):163\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKwon OW, Song JH, Roh MI. Retinal Detachment and Proliferative Vitreoretinopathy. Dev Ophthalmol. 2016;55:154\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000438972\u003c/span\u003e\u003cspan address=\"10.1159/000438972\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIdrees S, Sridhar J, Kuriyan AE. Proliferative Vitreoretinopathy: A Review. Int Ophthalmol Clin. 2019;59(1):221\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/IIO.0000000000000258\u003c/span\u003e\u003cspan address=\"10.1097/IIO.0000000000000258\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-retina-and-vitreous","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJRV","sideBox":"Learn more about [International Journal of Retina and Vitreous](https://jneurodevdisorders.biomedcentral.com/)","snPcode":"40942","submissionUrl":"https://submission.nature.com/new-submission/40942/3","title":"International Journal of Retina and Vitreous","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Rhegmatogenous Retinal Detachment, Proliferative Vitreoretinopathy, Pneumatic Retinopexy, Case Series, Treatment Outcome, vitreoretinal surgery, retinal surgery repair","lastPublishedDoi":"10.21203/rs.3.rs-6769128/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6769128/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRhegmatogenous retinal detachment (RRD) management continues to evolve with techniques such as scleral buckle, pars plana vitrectomy, and pneumatic retinopexy (PR). PR, a less invasive procedure, may offer advantages in resource-constrained settings. This case series aims to describe baseline characteristics and PR outcomes in patients eligible for the PIVOT trial at a Colombian tertiary center.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRetrospective case series study (January 2021 - April 2024) at a single center in Barranquilla, Colombia, included 143 (25.40%) of 563 consecutive RRD cases meeting PIVOT criteria (single superior break ≤ 1 clock hour in detached retina; any breaks/lattice in attached retina). Exclusion criteria included inferior breaks, media opacity, PVR ≥ B, prior detachment/PPV, age \u0026lt; 18, incapacity, or inability to posture. Retinal reattachment status was recorded at 3 months. The primary outcome was the single-operation success (SOS) rate of PR, defined as complete retinal reattachment at 3 months with one procedure (allowing additional gas within 21 days). Descriptive statistics, Chi-square, t-tests, and Mann-Whitney U tests were used for analysis (p value 0.05 significance).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nOf 563 RRD cases, 143 (25.4%) met PIVOT criteria. Exclusions primarily involved inferior breaks (32.6%) or PVR ≥ B (27.6%). Among 105 PIVOT-eligible patients receiving PR, SOS rate was 85.7%. Baseline factors (age, sex, lens, macular status) were similar between success (n = 90) and failure (n = 15) groups (p \u0026gt; 0.05). Detachments \u0026gt; 2 quadrants associated with failure (p = 0.045; use caution). Symptom-to-procedure time similar.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately 25% of primary RRD patients met PIVOT criteria, indicating significant PR caseload potential. The high observed PR SOS rate supports its feasibility and effectiveness for appropriately selected patients in resource-constrained settings like Colombia.\u003c/p\u003e","manuscriptTitle":"Baseline characteristics of rhegmatogenous retinal detachments meeting the PIVOT trial criteria in an eye referral center in Colombia: case series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 10:19:10","doi":"10.21203/rs.3.rs-6769128/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-15T08:19:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-14T05:50:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108357070789991288338226018611819687434","date":"2025-06-30T21:37:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-23T12:15:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254035089198689880420432210104591707298","date":"2025-06-16T09:18:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-03T10:54:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-02T10:04:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-30T11:53:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Retina and Vitreous","date":"2025-05-28T14:23:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-retina-and-vitreous","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJRV","sideBox":"Learn more about [International Journal of Retina and Vitreous](https://jneurodevdisorders.biomedcentral.com/)","snPcode":"40942","submissionUrl":"https://submission.nature.com/new-submission/40942/3","title":"International Journal of Retina and Vitreous","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"98e7a1a0-0b54-4999-824a-e0c59a70f9dc","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-31T09:53:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-09 10:19:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6769128","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6769128","identity":"rs-6769128","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}