الفهرس 
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Abstract
Summary
A rhegmatogenous retinal detachment occurs due to a
break in the retina that allows fluid to pass from the vitreous
space into the subretinal space. So treatment of a case of RRD
depends on sealing of that break and absorption of subretinal
fluid. Surgical strategies should be individualized based on a
variety of factors. These should include the number, size, and
location of the retinal breaks; the extent of the traction exerted
on the retina; the lens status; the patient’s expected ability to
comply with postoperative positioning requirements; the
available operating room equipment and support staff; the
experience and preferences of the surgeon; and the preferences
of the patient and caregivers. Using these guidelines, and the
surgeon’s best clinical judgment, anatomic reattachment and
favorable visual outcomes are achievable for the vast majority
of patients with primary rhegmatogenous RD. ne of these surgical strategies is pneumatic retinopexy
which is a 2-step procedure. In the first step, an expanding gas
bubble is injected into the vitreous cavity and the patient is
positioned so that the bubble closes the retinal break,
permitting resorption of subretinal fluid. The second step
entails induction of a chorioretinal adhesion around all retinal
breaks with cryopexy, laser, or both. And In general, the best
candidates for pneumatic retinopexy are those who have a
single retinal break or group of retinal breaks that are not
larger than 1 clock hour (30°) and that are located in the
superior 8 clock hours of the globe. Furthermore, the patient
must have the ability to maintain a proper head position for at
least 16 hours per day for 5 days or more.Patients with a retinal detachment not satisfying these
criteria are expected to be treated with:
scleral buckle which is inward indentation of the sclera
from the exterior, creating a ridge (or buckle) that reduces the
tear to allow for the reapposition of separated layers, thus
reestablishing their physiologic connection. In addition to the
placement of the explant , it is important that the retinal tears
are sealed by the formation of chorioretinal adhesions. This is
performed by cryotherapy, diathermy, or laser energy. In
conjunction with the generation of such adhesions, closure of
the break by the explant enables the attachment of the retina.
There may also be indications for auxiliary procedures during
the placement of the scleral buckle, such as the removal of
accumulated subretinal fluid and/or the injection of intravitreal
gas. The best candidate for scleral buckle is Phakic patients
with small single equatorial break uncomplicated.
It may be also treated with pars plana Vitrectomy which
involves removing the vitreous and relieving primary
vitreoretinal traction. The subretinal fluid is drained internally
through the retinal break or through a separately created
drainage retinotomy. After the retina is flattened, endolaser
photocoagulation is used to create chorioretinal adhesion. Intraocular
gas bubble or silicone oil can be used to provid amponade to the retinal breaks in the postoperative period.
Many types of detachments are not amenable to repair by
scleral buckling and need to be dealt with vitrectomy, such as
those with giant retinal tears, proliferative vitreoretinopathy,
proliferative diabetic retinopathy, posterior retinal breaks, and
breaks with significant vitreous hemorrhage or media
opacities.Also combined PPV/SB may be indicated to repair a
primary retinal detachment. In these situations, a solid silicone
encircling element is placed around the eye to support the osterior vitreous base and a vitrectomy is performed and
drainage of subretinal fluid is performed internally. The
PPV/SB can be used in situations where there is widespread
peripheral pathology associated with a retinal detachment like
severe PVR, inferior traction and incomplete removal of
traction. The encircling band provides support to the vitreous
base, while vitrectomy removes the direct vitreoretinal traction
that is present.