Following the introduction of closed vitrectomy techniques by Robert Machemer in the early 1970s, complicated retinal detachments became one of the important indications for vitreous surgery. Most of these were due to proliferative diabetic retinopathy (PDR) or to proliferative vitreoretinopathy (PVR), frequently following failure of routine scleral buckling procedures. As experience in vitreoretinal surgery expanded, the advantages of these techniques in the management of more routine types of retinal detachment became apparent. The popularity of vitrectomy for primary retinal detachments continues to grow, particularly with regard to pseudophakic cases. Indications for performing a vitrectomy rather than a scleral buckle or a pneumatic retinopexy are summarized in Chapter 10. Virtually all authorities note that a vitrectomy is required (along with a broad scleral buckle) in eyes with severe PVR, and the technique is also clearly indicated for cases due to PDR, detachments associated with major vitreous hemorrhage or scarring from penetrating trauma, and those with giant retinal tears. On the other hand, few would suggest a vitrectomy to repair a very shallow and small retinal detachment due to a single break that could be easily closed with a scleral buckle or pneumatic procedure. Between these two extremes, indications remain a matter of personal choice of the surgeon, and they are influenced by his or her training and experiences with a variety of techniques. Most surveys demonstrate a growing popularity of vitrectomy for an increasing percentage of cases. The goals of vitrectomy for retinal detachment are to… 1. Remove axial opacities such a 1. s vitreous hemorrhage or debris. 2. Eliminate vitreoretinal, epiretinal, or subretinal traction. 3. Identify and treat all retinal breaks. 4. Internally reattach the retina. 5. Facilitate placement of a large intraocular tamponade. 6. Avoid complications associated with scleral buckling surgery…. The usual sequence of events includes removal of vitreous gel and epiretinal membranes, identification of retinal breaks, internal removal of subretinal fluid, laser therapy to all responsible breaks and areas of significant vitreoretinal degeneration, and placement of an internal tamponade with gas or silicone oil. Vitrectomy is frequently combined with placement of a scleral buckle.
Two Cases of Rhegmatogenous Retinal Detachment Associated with Asteroid Hyalosis