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