Vitrectomy as a Prevention for Retinal Detachment in High-Risk Eyes

Rhegmatogenous retinal detachment (retinal detachment, RD) is the most common cause of spontaneous vision loss in aging eyes that were seeing normally until the moment of its occurrence. Causative retinal breaks usually occur in the form of peripheral tears at the vitreous base, resulting from traction exerted by the aging vitreous as it detaches posteriorly. Peripheral encircling laser retinopexy increases retinal resistance to vitreous traction in high-risk eyes. To achieve maximal lifetime prophylaxis, we show that in selected high-risk cases the vitreous can thereafter be removed by advanced vitrectomy techniques, reducing vitreous traction itself. Plain Language Summary: Retinal detachment (RD) is a separation of the retinal layer from the back eye wall by passage of fluid through a retinal tear. It is analogous to wallpaper separating from a wall, and it is noticed as a sudden dark curtain developing in the field of vision. RD is the most frequent cause of spontaneous visual loss in aging eyes that have enjoyed normal vision until the moment of its occurrence. This Perspective article and its supplementary case series describe a method of reducing RD risk in selected eyes by surgery (vitrectomy) to remove the mobile, aging vitreous gel (see Figure 1 ) that moves with body motion, causing retinal tears. We show that the risk of such a vitrectomy has plummeted from almost 40% in the 1970’s to less than 1% today. Along with prior laser “welding”, it thereafter results in an eye with the lowest possible lifetime risk of RD.