Primary Retinal Detachment

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5 Vitrectomy for the Primary Management of Retinal Detachment
manently implanted material around the globe. The improved
visual outcomes in patients with macula-off retinal detachments
treated with pneumatic retinopexy compared with those treated
with scleral buckling is debatable. These two procedures do not
relieve the vitreous traction permanently and, thus, inherently
have a higher primary failure rate compared with scleral buckling.
Vitrectomy has appeal for retinal surgeons because of the ability to
remove vitreous traction internally, reducing the forces that cause
subretinal fluid to develop. It is usually easier to be sure that all of
the retinal breaks are found intraoperatively. Annoying vitreous
floaters are removed, and, in pseudophakic eyes, the refractive
error is changed minimally. These are attractive benefits that seem
to result from vitrectomy, and, increasingly, this approach is taken
by younger vitreoretinal surgeons in practice.
The choice of the surgical procedure will be dependent on the
surgeon’s comfort and experience with each of the available procedures.
The preference for the procedure should lead to the best
chances for the optimal outcomes – an attached retina with excellent
final visual result that synchronizes with the fellow eye. This
chapter will discuss my personal views on the indications, surgical
techniques, and published results of the management of primary
retinal detachment with vitrectomy.
Indications
The indications for the choice of vitrectomy as the primary
method for managing retinal detachment is quite varied among
surgeons. Some believe that it should be used in every case, and
others feel that a scleral buckle should be attempted first in all
cases before vitrectomy is done. Until the clinical evidence can
be established for each end of the spectrum, I have chosen an approach
that is somewhat more conservative and that balances the
risks of vitrectomy with its benefits.