Primary Retinal Detachment

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might eliminate traction on the break and reduce postoperative
anterior and posterior vitreous proliferation. The analysis in
Chap. 8 indicates that this aim has not been achieved; nevertheless,
the procedure is increasingly applied.
Primary vitrectomy has become a fourth option for repair of a
primary retinal detachment at the beginning of the twenty-first
century (Fig. 9.7). When supplemented by extensive barrier coagulations
and a cerclage, it is no longer a procedure limited to the
break.
Conclusion
9 Repair of Primary Retinal Detachment
In the beginning of the twenty-first century, the present state-ofthe-art
for repair of a primary retinal detachment has reverted from
a local to a barrier concept of treatment – as has happened several
times during the past 75 years.
External buckling: local buckles with coagulations limited to
the break (Fig. 9.5a, b) are becoming replaced by local buckles
supplemented by an encircling band with extended coagulations
(Fig. 9.4a, b), applied as a barrier against redetachments.
The same applies to pneumatic retinopexy: the primary intent
to limit treatment to the area of the tear (Fig. 9.6a) is given up –
again – in favour of a barrier concept by applying 360° of coagulations
(Fig. 9.6b).
A similar trend is becoming apparent with primary vitrectomy:
initially aimed at removing traction on the tear and limiting the coagulations
to the area of the tear (Fig. 9.7a), the procedure has been
extended by a circular barrier of coagulations with an encircling
band supplemented by a local buckle beneath the tear to prevent
redetachments (Fig. 9.7b).
Of the four surgical techniques in use at present for repair of a
primary rhegmatogenous retinal detachment, two are extraocular
operations (minimal segmental buckling with sponges or a balloon
without drainage and cerclage with drainage) and two are intra-