Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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90<br />
5 Vitrectomy for the <strong>Primary</strong> Management of <strong>Retinal</strong> <strong>Detachment</strong><br />
eyes after one operation and 96.7% after multiple operations. The<br />
surgical techniques did vary and might explain some of the differences<br />
in anatomic outcomes. In some series, concomitant scleral<br />
buckling was done [10], but in others, a scleral buckle was not used<br />
in any of the eyes [9]. Also, vitrectomy was done only in pseudophakic<br />
eyes, compared with other series that were operated without<br />
regard to the lens status. The most common causes of failure of the<br />
primary operation were missed retinal breaks or the development<br />
of PVR. In a series of 25 failed cases analyzed for the cause of failure,<br />
missed retinal breaks were responsible for 64.3% of failures [12].<br />
These cases were managed with vitrectomy revision with or without<br />
scleral buckling. The visual acuity outcomes are not stated in<br />
many of these reports, and it is not possible to determine if the<br />
outcomes are more favorable than in eyes treated with scleral<br />
buckling alone. Some retrospective reviews and randomized clinical<br />
studies comparing the anatomic outcomes between vitrectomy<br />
and scleral buckling as the primary operation have been reported<br />
[13–15]. In general, they report similar anatomic and visual outcomes<br />
and probably have too small a number of eyes to have sufficient<br />
power to detect a difference. A large prospective randomized<br />
study with matched retinal detachments would be required to find<br />
if there is a difference in visual acuity outcomes. Such a study would<br />
probably require hundreds of patients, since the anatomic reattachment<br />
rates are high both with scleral buckling and with vitrectomy<br />
and is currently in progress in Germany (SPR Study) [16].<br />
There are several advantages to the use of vitrectomy in the<br />
primary management of retinal detachment. Intraocular visualization<br />
is much improved, reducing the possibility of missing retinal<br />
breaks. In one prospective study of 51 eyes undergoing vitrectomy,<br />
7 (13.7%) eyes were found to have previously undetected retinal<br />
breaks, and additional holes were found in 21 (41%) eyes [17]. The<br />
traction on the tear is removed with vitrectomy with any vitreous<br />
debris or hemorrhage. Thus, the patient rarely sees “floaters” postoperatively.<br />
The retina is almost completely flattened at the time<br />
of surgery with the help of perfluorocarbon liquids, and there is
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