Primary Retinal Detachment

Technique 63
gas reflux. Following gas injection, the bubble size and position
are assessed, and central retinal artery perfusion is assured with
indirect ophthalmoscopy.
IOP rises abruptly in most patients who receive greater than
0.2 ml gas. The IOP is checked immediately following gas placement.
Frequently, pressure measurements fall in the 50–70 mmHg
range. If the patient has a normal aqueous outflow mechanism, he
or she can be monitored with serial tonometry every 10–15 min,
which frequently demonstrates a return to more normal pressures
over 15–30 min. Paracentesis, as noted above, may be performed
before or after gas injection (or both) to normalize IOP. The pressure
should be near normal and the central retinal artery perfused
prior to the patient’s departure.
Postoperatively, an antibiotic/steroid combination ointment is
placed in the eye, and a patch is applied. An arrow is drawn on the
patch, such that the arrow points straight at the ceiling when the
patient is properly positioned (break in uppermost position of the
globe). The patient and caregiver are reminded of the required position
with special emphasis on the need for compliance, especially
at night while asleep. The patient returns for follow-up on the
first postoperative day. The SRF is usually substantially improved
or entirely resolved. The gas bubble size and location are assessed,
and the IOP is measured. Laser may be performed as part of a
staged procedure (see above).For patients with extensive cryopexy,
antibiotic and steroid drops may be prescribed for a few days.
The importance of proper position is stressed yet again. In cases
where there is little or no change in the SRF, patient compliance is
reassessed, and an exhaustive exam for new or missed breaks is
undertaken. In the typical scenario where the fluid is substantially
better, the patient is re-examined on the third to fifth postoperative
day.