(Adapted from American Academy of Ophthalmology Retina Panel. Preferred Practice Pattern® Guidelines.

Precursors of Rhegmatogenous Retinal Detachment in Adults. San Francisco, CA: American Academy of Ophthalmology; 2008.)

90% of eyes with idiopathic epimacular proliferation. Also, when vitreoretinal traction causes a retinal tear, pigment epithelial cells are usually liberated into the vitreous cavity, and these may be a source of subsequent epimacular proliferation. The method of creating a chorioretinal adhesion appears to be unrelated to the incidence of postoperative macular pucker.

SUMMARY

Although prevention of retinal detachment is an important goal, the genuine value of prophylactic therapy for most vitreoretinal lesions remains unknown because of a lack of appropriate trials. Treatment of symptomatic flap tears is an accepted method of preventing clinical retinal detachments, because the natural course of these breaks and the results of therapy are well documented. In most other instances, treatment of visible abnormal vitreoretinal lesions is of limited value, even in eyes with additional risk features such as high myopia, pseudophakia, and history of retinal detachment in the fellow eye.

This chapter attempts to summarize briefly the literature on this topic (Table 6–2). Specific decisions regarding prophylaxis for a given eye should be made on the basis of the features of the case and expanding medical knowledge. Patients with highrisk features should be made aware of symptoms of posterior vitreous detachment and loss of visual field, and any patient with such symptoms should be promptly evaluated. In addition, periodic evaluations may be indicated.

SELECTED REFERENCES

American Academy of Ophthalmology Retina Panel. Preferred Practice Pattern® Guidelines:

Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration. San Francisco, CA: American Academy of Ophthalmology; 2008.