Primary Retinal Detachment

Discussion 137
macular and retinal diseases are increasingly available, however,
at very high costs.
Discussion
In recent publications, the results of primary vitrectomy have been
compared with the results obtained with scleral buckling. However,
the comparison was done with scleral buckling consisting of
a cerclage with extensive coagulations, with drainage of subretinal
fluid, and, frequently, with an intraocular gas tamponade.With that
comparison, it was concluded that scleral buckling has a higher
morbidity than primary vitrectomy [52–54]. Yet, had they compared
primary vitrectomy with minimal segmental buckling without
drainage, they would have concluded that segmental buckling
without drainage has less morbidity than primary vitrectomy [55].
Despite the excellent results that can be obtained with the minimal
buckling technique, vitrectomy as a primary procedure is increasingly
used. This is the case even though a recent analysis of
595 detachments treated with vitrectomy, performed by experts,
found that the rate of reoperation was 24.5% and PVR 11.5% [56] in
contrast to minimal segmental buckling with a rate of reoperation
at 7.3% and PVR at 1.9% (Table 6.3).
Retinal breaks, even small breaks, should be found preoperatively.
Postponing the search to the time of surgery should be a last
resort. Parenthetically, detecting breaks preoperatively is less costly
because the search uses only the time of the surgeon; a search for
breaks during surgery uses the time of additional personnel in attendance
in an expensively equipped operating room.
It is of interest that failing to close the break is still the main
cause of failure, regardless of the procedure employed. A recent
publication about 171 primary detachments treated with a primary
vitrectomy [57] demonstrated that the reason for primary failure
was a missed or leaking break in 64.3% of failures. In comparison,
the causes of the 91 primary failures after 962 sponge buckles