Ivan Fiser, Petr Bedrich, Frantisek Benda, Martina Rubesova (Prague, Czech Republic)

Advantages:

We do not have a universal preference in treating RD. We treat each patient individually, according to the finding, to his/her wishes, preferences and abilities, such as the ability of facedown positioning.

Methods:

We prefer scleral buckling in younger phakic patients while in pseudophakic detachment we more often perform vitrectomy, however, many exceptions exist. We use pneumatic retinopexy in RD without major traction and we even use a gas bubble to prevent progression of the detachment into the macula when the surgery cannot be performed immediately; this is a good option not only in a superior RD but even in an inferior or temporal one.
In cases of redetachment with PVR, namely an inferior RD under silicone oil, we often use the deeply and widely buried indent with scleral shortening. If the indent is already present and we try to avoid an aggressive retinectomy, we use heavy silicone oil. In all vitrectomies, knowing the experience of endoscopic surgeons, we try to dissect (i.e. peel, strip and shave) the vitreous base using thorough indentation and the enhanced visualization of the residual vitreous under air.

Effectiveness / Safety:

We believe this tailored surgery maximizes the benefit and safety of RD surgery. Different approaches will be illustrated using some case-reports.

Take home message:

No generally valid recipe exists; we should judge many factors to choose the proper technique and to gain the best result.