Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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Indications 83<br />
Table 5.1. Indications for vitrectomy in primary retinal detachment<br />
1. Vitreous opacity – hemorrhage, pigment/debris, uveitis,<br />
asteroid hyalosis<br />
2. Undetected retinal breaks<br />
3. Large posterior retinal tears usually associated with lattice<br />
degeneration<br />
4. Posterior retinal breaks in high myopia, colobomas,<br />
and staphylomas<br />
5. Failed pneumatic retinopexy<br />
6. Subretinal gas<br />
7. Selected cases of retinoschisis<br />
8. Giant retinal tears<br />
9. Proliferative vitreoretinopathy<br />
10. <strong>Retinal</strong> detachment following open globe injury<br />
<strong>Primary</strong> management with vitrectomy is reserved for selected<br />
types of retinal detachment that are more difficult to manage with<br />
scleral buckling alone. These types of retinal detachment are often<br />
more complicated using an external episcleral approach and are<br />
listed in Table 5.1. An internal approach allows better visualization<br />
of the retinal breaks, better removal of traction on the retina, or<br />
better repositioning of the detached retina (Figs. 5.1, 5.2). In some<br />
cases, an encircling scleral buckle may also be necessary to support<br />
the area of the vitreous base. A more detailed discussion of each<br />
situation follows below.<br />
Opacification of the vitreous may be sufficient to prevent adequate<br />
examination of the peripheral retina.These opacities may result<br />
from vitreous hemorrhage, pigment or debris, uveitis, or asteroid<br />
hyalosis.When a dense vitreous hemorrhage is present, there is<br />
a higher chance that proliferative vitreoretinopathy (PVR) will develop.<br />
The reason for this is not completely understood. Does the<br />
hemorrhage introduce cytokines that activate the proliferative<br />
processes, or is it the type of retinal tears (usually large flap tears)