Primary Retinal Detachment

Outcomes 91
almost no persistent subretinal fluid involving the macula. Thus, the
recovery of macular function starts immediately postoperatively.
Choroidal detachment is rarely seen in vitrectomized eyes. Endolaser
photocoagulation is more comfortable for the patient and may
cause less surgically-induced inflammation compared with cryotherapy.
If a scleral buckle is used in conjunction with vitrectomy,
it tends to be a smaller buckling element, especially with large
posterior retinal tears. In pseudophakic eyes, there is less change in
postoperative refractive error when no scleral buckle is used.
The complications of vitrectomy may affect the visual and
anatomic outcome. The possibility of iatrogenic retinal breaks as a
result of cutting near mobile retina or from vitreous incarceration
at sclerotomy sites increases the risk of failure. A large gas bubble
may be associated with glaucoma or with iris capture of an
intraocular lens. Unexplained visual field defects may also occur
after vitrectomy. Rarely, a retinal fold that involves the macula is
seen postoperatively. The patient complains of marked distortion.
Endophthalmitis is a rare but devastating complication. In phakic
eyes, the postoperative progression of nuclear cataract may be the
single reason that vitrectomy is not recommended routinely for
every retinal detachment. In a young patient with a clear lens in the
fellow eye, the loss of accommodation resulting from pseudophakia
can be quite disabling. Thus, whenever possible, it is preferable
to use an operation that will not increase the rate of cataract progression.
There are also economic considerations that may play a role in
the choice between vitrectomy and scleral buckling as the primary
treatment for retinal detachment. The cost of supplies for a scleral
buckling procedure is significantly less than that of a vitrectomy.
If cataract surgery is also required later, the cost difference is
multiplied. The rehabilitation time is increased after vitrectomy
compared with scleral buckling. In general, most of my patients
are able to return to work 1 week after scleral buckling. After
vitrectomy, most patients are incapacitated for 2–4 weeks because
of head positioning and inability to drive. There is a prolonged