Pars plana vitrectomy alone with diffuse illumination and vitreous dissection to manage primary retinal detachment with unseen breaks

Arch Ophthalmol. 2009 Oct;127(10):1297-304. doi: 10.1001/archophthalmol.2009.254.


Objective: To report on pars plana vitrectomy with diffuse illumination, wide-angle viewing, and meticulous vitreous dissection for identifying and managing retinal breaks when no breaks were detected before surgery for primary rhegmatogenous retinal detachment.

Methods: Prospective clinical study of 61 of 800 consecutive eyes (7.6%) (61 of 782 patients) seen at a university hospital during the 48-month study for primary rhegmatogenous retinal detachment in whom no break could be identified preoperatively despite thorough examinations. All of the patients underwent pars plana vitrectomy alone with meticulous peripheral vitreous dissection assisted by diffuse illumination, a wide-angle viewing system, perfluorocarbon liquid, triamcinolone acetonide suspension, and balanced salt solution to identify and manage primary retinal breaks.

Results: Retinal breaks were found intraoperatively in 60 eyes (98%). In 51 of 61 eyes (84%), balanced salt solution was left in the vitreous cavity. Best-corrected visual acuity was 20/40 or better in 25 of 61 study eyes (41%). Primary retinal reattachment was attained in 60 study eyes (98%). Final reattachment was achieved in all 61 eyes (100%).

Conclusions: Pars plana vitrectomy alone with diffuse illumination and extensive vitreous dissection led to identification and management of retinal breaks undetectable before surgery, achieving a high primary reattachment rate.

MeSH terms

  • Acetates
  • Adult
  • Aged
  • Aged, 80 and over
  • Cryosurgery
  • Drug Combinations
  • Female
  • Fluorocarbons / administration & dosage
  • Humans
  • Intraoperative Period
  • Lighting
  • Male
  • Middle Aged
  • Minerals
  • Prospective Studies
  • Retinal Detachment / surgery*
  • Retinal Perforations / diagnosis*
  • Retinal Perforations / surgery*
  • Silicone Oils / administration & dosage
  • Sodium Chloride
  • Triamcinolone Acetonide
  • Visual Acuity / physiology
  • Vitrectomy*
  • Vitreous Body / surgery*
  • Young Adult


  • Acetates
  • BSS solution
  • Drug Combinations
  • Fluorocarbons
  • Minerals
  • Silicone Oils
  • Sodium Chloride
  • Triamcinolone Acetonide