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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. |