Third Category of Difficult Detachments

These are represented by pseudophakic detachments; the problem lies in the opacities of the optic media after an anterior segment surgery, which precludes finding the break and the application of minimal external buckling. However, the limits of external minimal buckling in this third category are in a gray zone.

Actually, the indication for a vitrectomy in these eyes, combined with a preceding anterior segment surgery, does not depend only on the size of the tear or the presence of vitreoretinal proliferation, but also on the expertise of the surgeon in diagnostics in the presence of optical interferences. Biomicroscopy with the use of the new indirect wide-field contact lenses combined with simultaneous depression of the retinal periphery and application of the 4 Rules for finding the primary break [19, 20] might enable a limited prospective buckling and reduce the need for an invasive surgery.

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