Question

A 21-year-old myopic male presented with a total retinal detachment in the right eye, a single causative break at 11 O’clock anterior to the equator, and no PVR.
What are the surgical options for management of retinal detachment?

Hint:

For a young myopic patient with a single break and no PVR, pneumatic retinopexy or scleral buckling are the most commonly recommended surgical options.

Answer 1

Retinal detachment (R is a serious condition that requires prompt surgical intervention to prevent permanent vision loss. The surgical options for managing retinal detachment depend on the location and extent of the detachment, the presence of complications like proliferative vitreoretinopathy (PVR), and the characteristics of the retinal break(s). In this case, the patient is young, myopic, and has a single break without PVR, which influences the choice of surgical technique.
The main surgical options for retinal detachment are:
1. Pneumatic Retinopexy:
- This procedure involves injecting a gas bubble into the vitreous cavity to tamponade the retinal break, allowing the retina to reattach.
- It is typically used for smaller, localized detachments with a single break, especially when no significant PVR is present.
2. Scleral Buckling:
- A scleral buckle involves placing a silicone band around the sclera to indent the wall of the eye and relieve the traction from the detachment, especially around the retinal break.
- It is effective for anterior detachments, such as the case described here (11 o'clock break), and provides long-term success when no significant PVR is present.
3. Vitrectomy:
- A pars plana vitrectomy (PPV) is a more invasive procedure that involves removing the vitreous gel and reattaching the retina using either a gas bubble or silicone oil.
- This technique is often used for posterior or extensive detachments, or in cases with complications like PVR. However, in this case with no PVR, it might not be the first choice.
4. Combined Procedures:
- In some cases, a combination of vitrectomy and scleral buckling is performed, particularly for more complex or recurrent detachments.