Surgical management of recurrent rhegmatogenous retinal detachment

ABSTRACT Introduction Primary rhegmatogenous retinal detachment (RRD) repair with modern surgical techniques provides high rates of anatomic success; however, anatomic failure may still occur with any primary surgery, including after pneumatic retinopexy (PR), scleral buckle (SB), and pars plana vitrectomy (PPV), resulting in recurrent RRD. Areas covered This review includes a summary of surgical options and management strategies for eyes with primary failure of PR, SB, and PPV. Expert opinion No standardized protocol is available for determining the optimal secondary surgical options to treat recurrent RRD. However, understanding of the causes and characteristics of the re-detachment, expected anatomic success rates with each surgical option, and potential complications, may improve the outcomes after re-operations. Causes of primary failure include formation of new breaks, re-opening of the original breaks, missed breaks, and most commonly, proliferative vitreoretinopathy (PVR). Rescue PR, revision of SB, and reoperation with PPV with membrane peeling, relaxing retinectomy, and/or long-acting tamponade combined with or without encircling SB, are effective options depending on the cause of primary failure and characteristics and severity of the re-detachment. Further advances in the management of PVR, which is a major cause of primary failure, will help improve treatment outcomes for eyes with complicated recurrent detachments.