This involves the sewing of small inert pieces of material, usually silicone rubber, onto the outside of the sclera in such a way as to make a suitable indent at the site of the tear (Figure 13.4). This is combined with cryopexy to the break. It is often necessary to drain off the sub-retinal fluid and inject air or gas into the vitreous. In more difficult cases, the eye can be encircled with a silicone strap to provide all-round support to a retina with extensive degenerative changes.

Figure 13.5. Vitrectomy.

do not achieve a full restoration of their central vision, although usually the peripheral field recovers. The degree of recovery of central vision in such macula-detached cases depends largely on the duration of the macula detachment before surgery. Even when the retina has been detached for two years, it is still possible to restore useful navigational vision.

The main cause of failure of modern retinal reattachment surgery is proliferative vitreo-retinopathy. This is characterised by excessive

"scarring" following initial retinal reattachment surgery, with the formation of fibrous tractional membrane within the eye, resulting in recurrent detachment of the retina.

When retinal surgery has failed, further surgery might be required and for a few patients a series of operations is necessary. If it is thought that more than one operation is going to be needed, it is helpful to the patient if he is warned about this before the treatment is started.

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