Primary Retinal Detachment

Indications 85
Fig. 5.2. The vitreous is excised along the vitreous base and traction
around the flap of the retinal tear is removed. Scleral depression is used to
assist in visualizing the anterior vitreous base
Failure of retinal reattachment has been reported for 31–43% of
these cases [4, 5].Vitrectomy allows better visualization of the peripheral
retina intraoperatively and offers a better chance to identify
the breaks and treat them.
Some retinal detachments are associated with large posterior
retinal breaks, usually in lattice degeneration (Fig. 5.3). These
breaks may occur in lattice degeneration with differing anteroposterior
levels. Sometimes a portion of the retinal tear extends
posterior to the equator. When the breaks are multiple, with long
patches of lattice degeneration, a wide posterior scleral buckling
element may be difficult to suture to the sclera and may deform the
shape of the globe, resulting in diplopia and anisometropia. Often
these eyes are highly myopic with thin scleral tissue. Thus, it may
be preferable to select vitrectomy and endophotocoagulation to
reduce the amount of surgical trauma in these cases.