Primary Retinal Detachment

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5 Vitrectomy for the Primary Management of Retinal Detachment
Fig. 5.1. When the retinal detachment is bullous (left), adding perfluorocarbon
liquid after removing the central cortical vitreous can help to flatten
and immobilize the retina, creating additional space to excise the peripheral
vitreous. There is less likelihood of damage of the peripheral retina
as instruments enter through the sclerotomy incisions
that allow more retinal pigment epithelial cells to be liberated?
Clearing the vitreous opacity allows more accurate identification
of the retinal breaks and removal of stimulatory factors for PVR.
In approximately 1–4% of retinal detachments, retinal breaks
are not visualized. There are several reasons. In some cases, despite
careful funduscopic examination with indirect ophthalmoscopy
and contact lens examination, retinal breaks causing the retinal
detachment cannot be found. Eyes that have undergone cataract
surgery (aphakic or pseudophakic) are more likely to have small
retinal breaks in the vicinity of the vitreous base. In other cases,
anterior segment changes limit the visualization of the fundus.
These include cortical lens opacities in phakic eyes, or capsular
phimosis or peripheral capsular opacities in pseudophakic eyes.
Microcornea or a small pupil may also prevent adequate evaluation
of the retina. There is a worse prognosis in cases where a retinal
break cannot be found when treated with scleral buckling alone.