The detached retina can also be reattached from within the vitreous cavity. This involves the use of fine-calibre instruments inserted through the pars plana into the vitreous cavity. A light probe is used to illuminate the operative field, while a "vitrectomy cutter" is used to remove the vitreous, hence relieving the abnormal vitreous adhesions that produced the retinal tear in the first instance (Figure 13.5). The detached retina is "pushed back" into place from within and temporarily supported by an internal tamponade agent (air, gas or silicone oil) while the retina heals. The retinal breaks are identified and treated by either laser photocoagulation or cryopexy at the same time. Vitrectomy can also be combined with a silicone strap encirclement if further support of the peripheral retina is needed.
Historically, vitrectomy is reserved for the more difficult and complex cases of rheg-matogenous retinal detachment, where multiple tears and posteriorly located tears are present, or as a "salvage" operation following failed cryo-buckle. With advances in instruments, vitrec-tomy is increasingly being used as the primary operation for the repair of most acute PVD-related rhegmatogenous retinal detachments, regardless of the complexity of the detachment.
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