Primary Retinal Detachment

Discussion 71
surgical failures. Failure to close the initial break and re-opening of
the initial break are typically grouped together. This problem is
encountered in 5% to14% of cases [13, 15] and is responsible for 25%
to 51% of surgical failures. PVR occurs postoperatively in 3% to 13%
of cases in reported series [3, 9, 10–18], though fortunately, it is a
rare cause of failure.
Discussion
Rhegmatogenous retinal detachment is a very heterogeneous
disease state, and, as a result, comparison of surgical results of different
techniques is difficult. Certainly PR, primary PPV, and SB
each have a place in a surgeon’s armamentarium of treatment
modalities. The use of PR is limited by anatomic considerations –
number, location and size of breaks, chronicity, preoperative PVR,
and lens status – while primary PPV and SB techniques can be used
for most cases of RRD. Nevertheless, PR has advantages in certain
clinical situations.
Advantages of PR
Given an optimal clinical scenario, PR has several advantages over
primary PPV and/or SB for the repair of a RRD. Pneumatic
retinopexy is usually performed in the office or as a brief procedure
in an outpatient surgical facility. In a multicenter trial reported
by Tornambe [13], the average number of hospital days including
re-operations was 0.6 days for the PR group and 2.7 days
for the SB group. The physician spends less time waiting for availability
of the operating room, performing the procedure, and performing
post-operative hospital rounds. It should be noted, however,
that since this publication in 1989, the majority of procedures,
including PR, primary PPV, and SB, are now performed in an outpatient
setting.