Primary Retinal Detachment

Discussion 167
Fig. 8.2. The small detachment (upper left) and the more extensive one
(upper right) both responded to a radial sponge buckle (lower center). The
larger detachment attached after only a few additional hours
coagulation, constriction by the encircling band, and the draining
of subretinal fluid – all of which contribute to a breakdown of the
blood–aqueous barrier and the infusion of cells and protein that
provoke PVR. Of the 2% that failed to attach because PVR prevented
closure of the break with a buckle, vitrectomy could attach half
of them. Thus, blindness from a retinal detachment, which was inevitable
before 1929, was a rare event at the end of the twentieth
century. Why the current swing to an intraocular procedure, which
our analysis indicates has a greater morbidity in terms of requiring
2nd surgeries and causing PVR? – We suggest that the reasons are
external and not related to results.