Primary Retinal Detachment

Indications 83
Table 5.1. Indications for vitrectomy in primary retinal detachment
1. Vitreous opacity – hemorrhage, pigment/debris, uveitis,
asteroid hyalosis
2. Undetected retinal breaks
3. Large posterior retinal tears usually associated with lattice
degeneration
4. Posterior retinal breaks in high myopia, colobomas,
and staphylomas
5. Failed pneumatic retinopexy
6. Subretinal gas
7. Selected cases of retinoschisis
8. Giant retinal tears
9. Proliferative vitreoretinopathy
10. Retinal detachment following open globe injury
Primary management with vitrectomy is reserved for selected
types of retinal detachment that are more difficult to manage with
scleral buckling alone. These types of retinal detachment are often
more complicated using an external episcleral approach and are
listed in Table 5.1. An internal approach allows better visualization
of the retinal breaks, better removal of traction on the retina, or
better repositioning of the detached retina (Figs. 5.1, 5.2). In some
cases, an encircling scleral buckle may also be necessary to support
the area of the vitreous base. A more detailed discussion of each
situation follows below.
Opacification of the vitreous may be sufficient to prevent adequate
examination of the peripheral retina.These opacities may result
from vitreous hemorrhage, pigment or debris, uveitis, or asteroid
hyalosis.When a dense vitreous hemorrhage is present, there is
a higher chance that proliferative vitreoretinopathy (PVR) will develop.
The reason for this is not completely understood. Does the
hemorrhage introduce cytokines that activate the proliferative
processes, or is it the type of retinal tears (usually large flap tears)