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Primary Retinal Detachment

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<strong>Retinal</strong> <strong>Detachment</strong> Repair: Outlook for the Future 203<br />

Fig. 10.14. Stereo photograph of old giant retinal tear with cyst. Fellow<br />

eyes are at high risk<br />

trial techniques. The network of academic collaborations will be<br />

able to be formalized, and individual physicians will be able to collaborate<br />

seamlessly. Clinical science will also advance as we learn<br />

more about genetics and other cofactors that predispose to retinal<br />

detachment. Our knowledge of who is at high risk for retinal detachment<br />

remains rudimentary. We know that fellow eyes are at<br />

risk, particularly in certain conditions (Fig. 10.14); but there remains<br />

great controversy as to the role of prophylaxis of peripheral<br />

retinal lesions that may be related to retinal detachment. Clearly, as<br />

we learn more about risk factors, the role of different types of prophylaxis<br />

will become better understood. This, in conjunction with<br />

more facile ways to perform clinical trials and surveys, will allow<br />

preventive treatment algorithms to evolve.<br />

The pioneering work of Sawa and Tano in Osaka has shown<br />

us that it is not instrumentation of the vitreous itself, but infusing<br />

of fluids that is likely the cause of nuclear sclerosis and<br />

cataract induction after vitrectomy [8]. As vitreous surgery is applied<br />

to eyes with relatively good visual potential, the side effect<br />

of cataract is more clinically important. Our indications for vitrectomy<br />

in the repair of retinal detachment and for other diseases<br />

may expand considerably if we can avoid cataract formation in<br />

these eyes.

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