The surgical approach to repairing retinal detachment (RD) has been a success story since Jules Gonin identified the retinal breaks to be the cause of retinal detachment. The techniques however have evolved over the years. Three techniques in particular, namely scleral buckling (SB), pars plana vitrectomy (PPV) and pneumatic retinopexy (PR), have been proved to be most successful and are therefore used around the world by almost all vitreoretinal surgeons. However, clinical trials have not compared the 3 techniques and have not addressed all the issues around which technique to choose and henceforth, there has been no consensus on which technique to use for what. For some surgeons, it often seems a matter of adopting a “one size fits all” approach. For others, commonly the available evidence is insufficient or inadequate. I will be defending the position that there must be an individualised, logical and evidence-based approach to selecting the technique for repairing RD that should aim to:

  1. achieve the highest success rate,
  2. minimise the complications, and
  3. lead to the best visual outcome.

So, using the best available evidence, the approach I will be recommending and defending is the following:

  1. In patients with no posterior vitreous detachment (PVD), who are commonly young and phakic, SB would be most appropriate. SB in those patients avoids the risk of inducing retinal tears intraoperatively while trying to induce the PVD and it also avoids causing premature cataract,
  2. In patients with tractional retinal tears resulting from PVD or those with complex retinal detachment e.g. in the presence of a giant retinal tear, vitreous haemorrhage, proliferative vitreoretinopathy (PVR) or retinoschisis, PPV will be the best method as it would allow the removal of the traction by the vitreous or by the PVR membranes, which is essential for helping the reattachment of the retina, and
  3. in a small number of patients with a single superior retinal break and shallow subretinal fluid or in those who are either unsuitable or averse to having surgery, PR would be appropriate.

I will be supporting my approach using the best available evidence for each one of the above indications and illustrating using case studies and video clips from surgery and showing my own institution and personal data. This will help establish for the audience how using of the above approach will ensure the best anatomical and visual outcome and will reduce the risk of intraoperative and postoperative complications.

Contact Details:

Cell Phone: +447939274217

Mostafa Elgohary