Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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2 Prophylaxis in Fellow Eye of <strong>Primary</strong> <strong>Retinal</strong> <strong>Detachment</strong> 31<br />
will progress to a retinal detachment either very soon or within<br />
2–3 months. Among eyes discovered with fresh tractional retinal<br />
tears but which have not yet led to retinal detachment, it has been<br />
well established that about 35% will lead to retinal detachment<br />
[34–36].<br />
Therefore, prompt examination of patients with suggestive<br />
symptoms of vitreous detachment, followed by prompt treatment<br />
of any new tractional retinal tears, is mandatory and will provide<br />
a high probability of preventing further progress to a retinal<br />
detachment, which is a much more serious event. Altogether these<br />
account for approximately 95% of all retinal detachments. If all<br />
fresh retinal tears resulting from posterior vitreous detachment<br />
were discovered at the time when no retinal detachment was yet<br />
present, and were successfully treated at that time, then approximately<br />
44% of retinal detachment in general could be prevented<br />
(Table 2.4). We must remember that about two-thirds of the eyes<br />
with such tears would never progress to detachment even without<br />
treatment. Herein lies a very great opportunity for the successful<br />
prevention of this historic and continuing scourge of vision.<br />
It may be thought that eyes that undergo a sudden posterior<br />
vitreous detachment may have a still higher risk if they contain<br />
pre-existing visible predisposing lesions related to retinal detachment.<br />
However, in a large prospective study of such eyes [14] it was<br />
Table 2.4. Fate of new retinal tears resulting from posterior vitreous<br />
detachment<br />
Progressing promptly to retinal detachment 28%<br />
(before consulting ophthalmologist)<br />
Expected to progress to detachment 24%<br />
(without treatment) = 72/3<br />
Total progressing to retinal detachment 52%<br />
(without treatment)<br />
Proportion of retinal detachments prevented (in general) 44%