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Primary Retinal Detachment

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74<br />

scleral depression is routinely performed, thereby allowing discovery<br />

of previously missed breaks. PPV, especially when performed<br />

under wide-field viewing, allows extensive, high-magnification,<br />

peripheral examination under anesthesia. In addition, PPV will remove<br />

media opacities, such as an opacified posterior capsule, vitreous<br />

hemorrhage, or vitreous debris, resulting in a superior view<br />

of the retinal periphery.<br />

New retinal breaks do occur following PR. It is postulated that a<br />

gas bubble within the vitreous cavity creates additional vitreoretinal<br />

traction, particularly when the bubble is positioned between<br />

the retina and posterior hyaloid face. These breaks may occur in<br />

any quadrant, but 76% are located in the superior two-thirds of the<br />

retina, and 52% are located within 3 clock hours of the original<br />

causative break. The majority (59%) of new breaks occur during<br />

the first postoperative month [13]. Prophylactic 360° peripheral<br />

barricade laser has been advocated to reduce the risk of new and/<br />

or missed retinal breaks. Tornambe [14] found a single operation<br />

success rate of 55% when focal retinopexy was employed compared<br />

with 85% for patients following 360° retinopexy. Presumably, this<br />

difference was due to a lower number of failures due to new and/or<br />

missed breaks in the 360° retinopexy group.<br />

Conclusion<br />

4 Pneumatic Retinopexy for <strong>Primary</strong> <strong>Retinal</strong> <strong>Detachment</strong><br />

Pneumatic retinopexy certainly has a place alongside SB and primary<br />

PPV in the constellation of surgical techniques for the repair<br />

of RRD. It is evident that PR has a lower single procedure primary<br />

anatomic success rate than the other techniques in most clinical<br />

situations. During informed consent discussions with patients,<br />

when describing the risks and benefits of the various treatment options,<br />

PR shines forth. Patients frequently choose PR, in spite of its<br />

lower primary success rate, because of the perceived benefit of less<br />

pain, less time away from work and favored activities, less surgical<br />

risk, and lower costs. It is reasonable to try PR first in favorable

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