Primary Retinal Detachment

30
2 Prophylaxis in Fellow Eye of Primary Retinal Detachment
degeneration, senile retinoschisis, retinal breaks, and cystic retinal
tufts also have a significant prevalence rate in primary eyes. Here,
also the natural histories as well as the futility of applying so-called
“prophylactic” treatment has been amply documented [23–26].
In summary, we may say that the well-established practice of
applying “prophylactic” treatment to visible predisposing peripheral
retinal lesions, whether in primary eyes or in fellow eyes,
before any detachment has occurred, and specifically for the purpose
of preventing this outcome has by now been thoroughly
discredited and must be discarded as the “standard of care”. This
answers the first major question of this chapter, and constitutes,
“What NOT to do”.
This does not mean however that retinal detachments cannot
be prevented. However, our clinical attention must be directed to a
completely different matter.We should not treat asymptomatic eyes
(whether primary or fellow eyes), but we should be on the lookout
for patients who complain of recent visual symptoms that suggest
the occurrence of a posterior vitreous detachment. Such symptoms
consist of the sudden appearance of vitreous floaters or light flashes.
It has been reported that among patients older than 50 years of
age, the symptom of suddenly appearing floaters is known to be
caused by posterior vitreous detachment in 95% of cases [27].
Patients with this complaint all should be thoroughly and conscientiously
examined with indirect ophthalmoscopy and simultaneous
scleral indentation in both eyes, to search for any new tractional
retinal tear or tears that may be present. If such are discovered
they should be promptly treated by surrounding them
with either laser photocoagulation or cryotherapy. It has been
found in several clinical series [14, 28–31] and in an autopsy series
by Foos [32] that about 15% of eyes that have had a vitreous detachment
also have a tractional retinal tear or tears. It has been reported
that around 28% of these will progress to a retinal detachment
before the patient first consults an ophthalmologist [33].
If the remaining 72% of eyes with fresh retinal tears are not
promptly discovered and treated, about one-third of this number