Evolving Surgical Management of Rhegmatogenous Retinal Detachments

Recognition of vitreoretinal traction and retinal breaks in the pathogenesis of rhegmatogenous retinal detachment (RRD) by Gonin in 1919 ushered in the era of surgical treatment. Since then multiple treatment strategies including scleral buckling (SB), pars plana vitrectomy (PPV), and pneumatic retinopexy have evolved. While all are effective treatments, much attention has shifted to determining the best treatment for a patient based on factors such as lens status and presence of complicating factors such as choroidal detachments, proliferative vitreoretinopathy, multiple tears, significant hypotony, or presence of giant retinal tears. Thus far the available data suggest that for uncomplicated phakic detachments both PPV and SB are reliable options, though due to cataract formation SB may be favorable in these patients. For pseudophakic RRDs, the data seem to suggest PPV has a higher single operation success rate than SB. Moreover in complicated RRDs, PPV has a more favorable outcome.