Rhegmatogenous retinal detachment: current opinion

Rhegmatogenous retinal detachment (RRD) is a severe ocular disorder which requires prompt treatment to prevent low vision and blindness. It is also a significant socio-economic problem as 84% of RDD patients are able-bodied. RRD grading systems (including current Machemer grading system), risk factors, and pathogenesis are reviewed. The role of proliferative vitreoretinopathy in RDD pathogenesis and recurrence is described. Macula involvement determines RDD outcome. Optical coherence tomography (OCT) provides the study of retina anatomy and the analysis of parameters that affect post-op best corrected visual acuity, i.e., defects of the junction between inner segments and outer segments (IS/OS), the integrity of external (ELM) and internal limiting membrane (ILM), outer nuclear layer thickness (ONLT) etc. Fluorescent angiography allows to understand the reasons for low vision in anatomically successful RDD surgery. Scleral buckling, balloon buckling, pneumatic retinopexy, vitrectomy, cryopexy, and laser coagulation are important tools in surgical armamentarium. In recent years, vitrectomy is growing in popularity for RDD treatment. Criteria for procedure selection and surgical success rate in phakic and pseudophakic eyes are discussed. The outcomes of vitrectomy with air/gas and silicone oil tamponade are compared. Bimanual vitrectomy benefits are discussed.