Primary Retinal Detachment

Chapter 5
Vitrectomy for the Primary Management
of Retinal Detachment
Stanley Chang
Introduction
Treatment options for the primary management of rhegmatogenous
retinal detachment have increased in recent years. The “gold
standard” approach has been the use of scleral buckling. The
success of the scleral buckle operation depends on two factors – the
ability of the surgeon to find and to localize all of the retinal breaks
and the surgical procedure to successfully close them on the buckle
without surgical complications. However, there are even varying
approaches and differing surgical techniques in the scleral buckle
operation. Controversy regarding surgical aspects, such as encirclement
versus localized buckle and drainage of subretinal fluid
versus non-drainage, persist among surgeons. In the end, the
success rates for anatomic retinal reattachment are high,ranging in
the 83–95% range after a single operation. Careful examination of
the retina combined with a compact surgical explant operation
that closes the retinal breaks as pioneered by Harvey Lincoff and
Ingrid Kreissig [1–3] is a very effective method for the treatment of
retinal detachment.
Newer techniques have sought to minimize the role of the
scleral buckle by either closing the retinal break temporarily internally
or externally until a chorioretinal adhesion can form around
it. These techniques include pneumatic retinopexy, temporary
balloon buckling, or vitrectomy. Both pneumatic retinopexy and
balloon buckling may be useful and most successful in selected
cases, offering a less invasive surgical procedure and avoid per-