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Primary Retinal Detachment

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Discussion 167<br />

Fig. 8.2. The small detachment (upper left) and the more extensive one<br />

(upper right) both responded to a radial sponge buckle (lower center). The<br />

larger detachment attached after only a few additional hours<br />

coagulation, constriction by the encircling band, and the draining<br />

of subretinal fluid – all of which contribute to a breakdown of the<br />

blood–aqueous barrier and the infusion of cells and protein that<br />

provoke PVR. Of the 2% that failed to attach because PVR prevented<br />

closure of the break with a buckle, vitrectomy could attach half<br />

of them. Thus, blindness from a retinal detachment, which was inevitable<br />

before 1929, was a rare event at the end of the twentieth<br />

century. Why the current swing to an intraocular procedure, which<br />

our analysis indicates has a greater morbidity in terms of requiring<br />

2nd surgeries and causing PVR? – We suggest that the reasons are<br />

external and not related to results.

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