Primary Retinal Detachment

New Possibilities 67
ing on type and amount of gas used as well as duration of followup
postoperatively.
New Possibilities
Surgeons continue to push the limits for detachments amenable
to treatment using PR. Detachments with breaks in more than one
quadrant may be repaired by augmenting the bubble size via a
second injection on the first or second postoperative day, or by
flattening one break over a 72-h period, then changing patient
positioning to address the second area in another quadrant [21].
The treatment of detachments with large breaks has been controversial.
Gas is more prone to migrate into the subretinal space, and
the arc of contact may not be broad enough to tamponade the entire
break. Nevertheless, reports exist of the successful use of PR for
RRDs due to giant retinal tear (4 of 5–80%), retinal dialysis (4 of
4–100%), and other large breaks [22–24]. These reports demonstrate
that PR can be effective for cases with large breaks if they are
located superiorly and lack significant vitreoretinal traction.
Pneumatic retinopexy has generally been avoided for RRD with
breaks in the inferior 4 clock hours of the fundus. Inverted PR has
been reported in phakic detachments. Utilizing 8 h of “head dangling”
positioning followed by laser retinopexy or cryopexy, the
single surgery reattachment rate was 9 of 11 (82%) [25]. It is evident
that although PR has an “ideal” scenario for its chief indication, the
technique is more widely applicable in certain select cases for those
with multiple breaks, large breaks, and even breaks located in the
inferior four clock hours.