Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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86<br />
5 Vitrectomy for the <strong>Primary</strong> Management of <strong>Retinal</strong> <strong>Detachment</strong><br />
Fig. 5.3. A large posterior retinal tear developing along postequatorial<br />
lattice degeneration (left). Postoperatively after the gas bubble has reabsorbed,<br />
the retinal tear is sealed by laser photocoagulation (right).<br />
No scleral buckle was placed, because of the tear’s posterior location<br />
Posterior retinal breaks, such as macular holes in highly myopic<br />
eyes and retinal breaks within the colobomatous area, are best<br />
managed initially with vitrectomy and gas tamponade. Placing a<br />
scleral buckle in these eyes may be difficult and more likely to have<br />
complications.<br />
Our experience in cases of failed pneumatic retinopexy often<br />
reveals that vitrectomy with or without scleral buckling is necessary.<br />
There may be persistent vitreous traction or even new retinal<br />
breaks that are better managed with vitrectomy. In cases that fail<br />
from gas bubbles expanding in the subretinal space, the best way to<br />
manage this situation is vitrectomy with the use of perfluorocarbon<br />
liquids to express the bubble from the subretinal space.<br />
Full thickness retinal detachments are seen in patients with<br />
retinoschisis when both, an inner layer and an outer layer retinal<br />
break, are present. In selected cases where the outer layer breaks<br />
are posteriorly located, vitrectomy may be preferable to scleral<br />
buckling. In cases where the breaks are peripherally located, scleral<br />
buckling is effective in reattaching the retina.<br />
Giant retinal tears and retinal detachment with PVR are complex<br />
forms of retinal detachment that are routinely managed with