The Goals of Surgery

All traction exerted on the retina should be eliminated, whether caused by pre-, intra-, or subretinal forces. The risk of traction recurrence should also be reduced. In addition to the factors already mentioned,53 the surgeon should follow certain principles:

50 Usually several weeks.

51 Surgery is also much easier if the PVR membranes are established since they are visible.

52 i.e., depending on the complications caused by the silicone oil

53 See under PVR prophylaxis.

• Remove all vitreous, both posteriorly and anteriorly. In the periphery, scleral indentation must be used to assure that no residual vitreous is present. If the surgeon feels that the lens prevents completion of this task, the lens must be sacrificed (see below).

• The injection of trypan blue54 is very useful to demonstrate the presence of membranes that are immature or difficult to notice.

• If the retina is shortened because of intrinsic traction, either a scleral buckle should be used55 or a retinotomy be performed.

• When considering retinotomy^6 the surgeon must be aware that if the retina is cut from its peripheral insertion, it can quickly "roll up like a rug" if traction persists/recurs centrally. Retinotomy should therefore be performed only if the PVR recurrence risk is low.

• The retinotomy may be carried out with scissors or the vitrectomy probe, but either should be preceded by sufficient diathermy to prevent bleeding.

• The peripheral retina should be removed with the vitrectomy probe (retinectomy).

O Pearl

If retinotomy is performed, the surgeon should err on the side of "too much," not "too little." A common cause for failure is residual traction at the edges of the retinotomy if retinal shortening is present.

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