Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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74<br />
scleral depression is routinely performed, thereby allowing discovery<br />
of previously missed breaks. PPV, especially when performed<br />
under wide-field viewing, allows extensive, high-magnification,<br />
peripheral examination under anesthesia. In addition, PPV will remove<br />
media opacities, such as an opacified posterior capsule, vitreous<br />
hemorrhage, or vitreous debris, resulting in a superior view<br />
of the retinal periphery.<br />
New retinal breaks do occur following PR. It is postulated that a<br />
gas bubble within the vitreous cavity creates additional vitreoretinal<br />
traction, particularly when the bubble is positioned between<br />
the retina and posterior hyaloid face. These breaks may occur in<br />
any quadrant, but 76% are located in the superior two-thirds of the<br />
retina, and 52% are located within 3 clock hours of the original<br />
causative break. The majority (59%) of new breaks occur during<br />
the first postoperative month [13]. Prophylactic 360° peripheral<br />
barricade laser has been advocated to reduce the risk of new and/<br />
or missed retinal breaks. Tornambe [14] found a single operation<br />
success rate of 55% when focal retinopexy was employed compared<br />
with 85% for patients following 360° retinopexy. Presumably, this<br />
difference was due to a lower number of failures due to new and/or<br />
missed breaks in the 360° retinopexy group.<br />
Conclusion<br />
4 Pneumatic Retinopexy for <strong>Primary</strong> <strong>Retinal</strong> <strong>Detachment</strong><br />
Pneumatic retinopexy certainly has a place alongside SB and primary<br />
PPV in the constellation of surgical techniques for the repair<br />
of RRD. It is evident that PR has a lower single procedure primary<br />
anatomic success rate than the other techniques in most clinical<br />
situations. During informed consent discussions with patients,<br />
when describing the risks and benefits of the various treatment options,<br />
PR shines forth. Patients frequently choose PR, in spite of its<br />
lower primary success rate, because of the perceived benefit of less<br />
pain, less time away from work and favored activities, less surgical<br />
risk, and lower costs. It is reasonable to try PR first in favorable