The Mini-Steamroll: An Abbreviated Variation of the Steamroller Maneuver Following Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment.

Purpose: To describe a novel positioning maneuver for patients with rhegmatogenous retinal detachment (RRD) following pneumatic retinopexy(PnR).

Methods: Single-center prospective case series of primary RRDs referred to St. Michael's Hospital, Toronto, Canada, between 2021 and 2023. All patients underwent PnR. Baseline ultra-widefield fundus imaging and repeat imaging 10 minutes after the gas injection was performed. After PnR, patients were instructed to perform the mini-steamroll maneuver which consists of a face-down position for ten minutes followed by positioning to the retinal break. The reduction of subretinal fluid (SRF) volume after the initial face-down position was evaluated with clinical examination and ultra-widefield imaging.

Results: Six patients who presented with primary bullous RRD and a sizable superior break were enrolled. The mini-steamroll maneuver resulted in a rapid and significant reduction of SRF in all patients with bullous RRD and large superior breaks, allowing subretinal fluid to be expressed into the vitreous cavity with 10 minutes of face-down positioning. One patient required a sequential PnR. Primary retinal reattachment was achieved in all cases .This approach was well-tolerated by patients.

Conclusion: This case series demonstrates that the mini-steamroll maneuver may be a suitable alternative for patient positioning following PnR in certain cases. The mini-steamroll is a simpler positioning regimen with the potential benefits of direct-to-break and full steamroller maneuver.