OPHTHALMOLOGIC SURGERY (K. DRENSER, SECTION EDITOR) Evolving Surgical Management of Rhegmatogenous Retinal Detachments Ankoor R. Shah • Ashkan M. Abbey • George A. Williams Ó Springer Science + Business Media New York 2015 Abstract Recognition of vitreoretinal traction and retinal breaks in the pathogenesis of rhegmatogenous retinal detachment (RRD) by Gonin in 1919 ushered in the era of surgical treatment. Since then multiple treatment strategies including scleral buckling (SB), pars plana vitrectomy (PPV), and pneumatic retinopexy have evolved. While all are effective treatments, much attention has shifted to determining the best treatment for a patient based on fac- tors such as lens status and presence of complicating fac- tors such as choroidal detachments, proliferative vitreoretinopathy, multiple tears, significant hypotony, or presence of giant retinal tears. Thus far the available data suggest that for uncomplicated phakic detachments both PPV and SB are reliable options, though due to cataract formation SB may be favorable in these patients. For pseudophakic RRDs, the data seem to suggest PPV has a higher single operation success rate than SB. Moreover in complicated RRDs, PPV has a more favorable outcome. Keywords Retinal detachment Á Vitrectomy Á Scleral buckle Á Pneumatic retinopexy Introduction: Historical Context Recognition of vitreoretinal traction and retinal breaks in the pathogenesis of retinal detachment by Gonin in 1919 ushered in the era of surgical treatment in which drainage of subretinal fluid and treatment of retinal breaks were employed (Fig. 1). Custodis, 30 years later, introduced the concept of scleral buckling (SB) [1, 2]. The introduction of the binocular indirect ophthalmoscope and scleral depres- sion by Schepens in 1951 revolutionized the localization of peripheral retinal pathology. In 1971, Machemer estab- lished the role of vitrectomy using a pars plana technique which has subsequently lead to many of the advancements in modern vitrectomy [3]. Attempting to develop a sim- plified outpatient procedure, Hilton and Grizzard described a two-staged office-based approach to retinal detachment repair via pneumatic retinopexy in 1986 [4]. Presently, each of these modalities has a role in the vitreoretinal surgeon’s armamentarium to address primary rhegmatog- enous retinal detachments (RRD). Current Treatment Options and Trends Scleral Buckling Little has changed in terms of the underlying principles of SB. The general surgical technique involves a peritomy (conjunctival opening) that is performed either at the lim- bus or several millimeters posterior to it. The recti are isolated, and the surface of the sclera is inspected. No aspect of SB is more critical than accurate placement of the buckle, requiring precise localization of retinal breaks on the scleral surface. For small flap tears or holes, a single mark on the posterior edge of the break is sufficient. Larger This article is part of the Topical Collection on Ophthalmologic Surgery. A. R. Shah Á A. M. Abbey Á G. A. Williams Associated Retinal Consultants, 3535 W 13 Mile Road, Suite 344, Royal Oak, MI 48073, USA G. A. Williams (&) Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, 3535 W 13 Mile Road, Suite 344, Royal Oak, MI 48073, USA e-mail: gwilliams@beaumont.edu 123 Curr Surg Rep (2015) 3:4 DOI 10.1007/s40137-014-0080-z