Primary Retinal Detachment

86
5 Vitrectomy for the Primary Management of Retinal Detachment
Fig. 5.3. A large posterior retinal tear developing along postequatorial
lattice degeneration (left). Postoperatively after the gas bubble has reabsorbed,
the retinal tear is sealed by laser photocoagulation (right).
No scleral buckle was placed, because of the tear’s posterior location
Posterior retinal breaks, such as macular holes in highly myopic
eyes and retinal breaks within the colobomatous area, are best
managed initially with vitrectomy and gas tamponade. Placing a
scleral buckle in these eyes may be difficult and more likely to have
complications.
Our experience in cases of failed pneumatic retinopexy often
reveals that vitrectomy with or without scleral buckling is necessary.
There may be persistent vitreous traction or even new retinal
breaks that are better managed with vitrectomy. In cases that fail
from gas bubbles expanding in the subretinal space, the best way to
manage this situation is vitrectomy with the use of perfluorocarbon
liquids to express the bubble from the subretinal space.
Full thickness retinal detachments are seen in patients with
retinoschisis when both, an inner layer and an outer layer retinal
break, are present. In selected cases where the outer layer breaks
are posteriorly located, vitrectomy may be preferable to scleral
buckling. In cases where the breaks are peripherally located, scleral
buckling is effective in reattaching the retina.
Giant retinal tears and retinal detachment with PVR are complex
forms of retinal detachment that are routinely managed with