06.02.2013 Views

Primary Retinal Detachment

Primary Retinal Detachment

Primary Retinal Detachment

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

82<br />

5 Vitrectomy for the <strong>Primary</strong> Management of <strong>Retinal</strong> <strong>Detachment</strong><br />

manently implanted material around the globe. The improved<br />

visual outcomes in patients with macula-off retinal detachments<br />

treated with pneumatic retinopexy compared with those treated<br />

with scleral buckling is debatable. These two procedures do not<br />

relieve the vitreous traction permanently and, thus, inherently<br />

have a higher primary failure rate compared with scleral buckling.<br />

Vitrectomy has appeal for retinal surgeons because of the ability to<br />

remove vitreous traction internally, reducing the forces that cause<br />

subretinal fluid to develop. It is usually easier to be sure that all of<br />

the retinal breaks are found intraoperatively. Annoying vitreous<br />

floaters are removed, and, in pseudophakic eyes, the refractive<br />

error is changed minimally. These are attractive benefits that seem<br />

to result from vitrectomy, and, increasingly, this approach is taken<br />

by younger vitreoretinal surgeons in practice.<br />

The choice of the surgical procedure will be dependent on the<br />

surgeon’s comfort and experience with each of the available procedures.<br />

The preference for the procedure should lead to the best<br />

chances for the optimal outcomes – an attached retina with excellent<br />

final visual result that synchronizes with the fellow eye. This<br />

chapter will discuss my personal views on the indications, surgical<br />

techniques, and published results of the management of primary<br />

retinal detachment with vitrectomy.<br />

Indications<br />

The indications for the choice of vitrectomy as the primary<br />

method for managing retinal detachment is quite varied among<br />

surgeons. Some believe that it should be used in every case, and<br />

others feel that a scleral buckle should be attempted first in all<br />

cases before vitrectomy is done. Until the clinical evidence can<br />

be established for each end of the spectrum, I have chosen an approach<br />

that is somewhat more conservative and that balances the<br />

risks of vitrectomy with its benefits.

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!