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Editorial |

Pars Plana Vitrectomy for Primary Retinal Detachment:  Persistent Anterior Peripheral Retinal Detachment

Ruwan A. Silva, MD; Harry W. Flynn, MD; Edwin H. Ryan, MD; Ryan F. Isom, MD
JAMA Ophthalmol. 2013;131(5):669-671. doi:10.1001/jamaophthalmol.2013.646.
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In the century since rhegmatogenous retinal detachment was first repaired by Jules Gonin,1 a variety of surgical techniques have been successfully used. From the introduction of the scleral buckle by Ernst Custodis, MD, in 1949 to the development of the pars plana vitrectomy (PPV) by Robert Machemer, MD, in 1971, the principles of retinal reattachment remain consistent: identify the retinal breaks, treat the retinal breaks, and relieve vitreoretinal traction. Contemporary techniques provide unparalleled opportunities to address a variety of complex retinal detachments, but these techniques should not steer vitreoretinal surgeons away from these basic principles.

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Figure 1. A 54-year-old man referred for evaluation 3 months after pars plana vitrectomy, endolaser treatment, and intraocular gas injection in the left eye. The posterior segment image shows a myopic fundus appearance (with a tilted optic disc and scleral crescent) and chorioretinal scars consistent with prior 360° laser retinopexy. Most significantly, a 360° anterior peripheral retinal detachment can be seen through the associated large retinal breaks (at the 6-o’clock and 9-o’clock positions) are not here visualized.

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Figure 2. A 38-year-old man referred for evaluation 6 months after pars plana vitrectomy, endolaser treatment, and silicone oil injection for a giant retinal tear in his left eye. Three months prior to evaluation, the patient underwent silicone oil removal. Posterior segment examination of the left eye demonstrated temporal pallor of the optic nerve, a mild epiretinal membrane in the macular region, retinal pigmentary alterations, and rows of laser retinopexy at the equator. An anterior peripheral retinal detachment was noted anterior to the laser treatment.

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Figure 3. A 42-year-old woman presented with a chief complaint of seeing “flashing lights” in her left eye. One year prior, she had undergone a pars plana vitrectomy and barrier laser demarcation for retinal detachment following a giant retinal tear in this eye. The posterior segment examination shows chorioretinal scars from prior laser retinopexy at the equator. An anterior peripheral retinal detachment is present anterior to the region of laser demarcation.

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