A 58-year-old man with high myopia presents with sudden onset of floaters and photopsia in his right eye. Fundoscopy reveals a superior temporal retinal detachment with a horseshoe tear. Regarding the pathophysiology and management of rhegmatogenous retinal detachment, all of the following are true EXCEPT:

Explanation

## Pathophysiology and Management of Rhegmatogenous Retinal Detachment ### Mechanism of Detachment **Key Point:** Rhegmatogenous retinal detachment occurs when a break in the neurosensory retina allows vitreous fluid to seep between the retina and the retinal pigment epithelium (RPE), causing separation and loss of blood supply from the choroid. ### Role of Vitreous Traction **High-Yield:** Vitreous traction at the site of a retinal break is indeed the primary mechanism that initiates and propagates rhegmatogenous detachment. This is a fundamental principle. ### Scleral Buckle Surgery — The Misconception **Warning:** The incorrect statement claims that scleral buckle "relieves vitreous traction." This is **FALSE**. Scleral buckle surgery works by: - **Indenting the sclera inward** to bring the RPE closer to the detached retina - **Relieving vitreous traction indirectly** by reducing the volume of the vitreous cavity - **Allowing the retinal break to reattach** to the RPE Scleral buckle does NOT directly relieve or eliminate vitreous traction — it circumvents the problem by anatomical repositioning. Vitreous traction relief is the mechanism of **pars plana vitrectomy**, not scleral buckle. ### Pneumatic Retinopexy Indications **Clinical Pearl:** Pneumatic retinopexy is **contraindicated in inferior retinal breaks** because gravity cannot keep the bubble in contact with a lower break. It is ideal for superior and superior temporal breaks in phakic eyes without PVR. ### Proliferative Vitreoretinopathy (PVR) **Key Point:** PVR is a serious complication characterized by epiretinal and subretinal fibrosis. It is more common in: - Eyes with delayed presentation (>2 weeks) - Extensive retinal breaks - Traumatic detachments - Recurrent detachments PVR significantly increases the risk of recurrent detachment and may require vitrectomy rather than scleral buckle alone. ### Summary Table | Concept | True/False | Explanation | |---------|-----------|-------------| | Vitreous traction initiates RRD | **TRUE** | Primary mechanism at the retinal break | | Scleral buckle relieves vitreous traction | **FALSE** | It indents the sclera; vitrectomy relieves traction | | Pneumatic retinopexy for inferior breaks | **FALSE** | Contraindicated; gravity works against bubble contact | | PVR more common in delayed presentation | **TRUE** | Risk increases with time and extent of detachment |