Retinal Detachment · Laser vs Scleral Buckle vs Vitrectomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Type + macular status/break location
   Rhegmatogenous/tractional/exudative? Macula involved? Break location?
   • Retinal break/degeneration only, no detachment, or subclinical → Break without detachment → laser/cryo
   • Rhegmatogenous, macula-on → Macula-on → emergency reattachment
   • Rhegmatogenous, single superior break, clear media → Single superior break → pneumatic retinopexy
   • Rhegmatogenous, complex (multiple/inferior breaks, PVR, pseudophakic, posterior) → Complex → vitrectomy ± buckle
   • Tractional (diabetic) or exudative → Tractional/exudative
2. [End] Break without detachment → laser/cryo
   Retinal break/lattice degeneration without detachment or subclinical detachment → laser photocoagulation/cryopexy to seal the break and prevent progression.
3. [End] Macula-on → emergency reattachment
   Macula-on → emergency, prompt surgery to seal the break and reattach to protect central vision; choose the approach by break characteristics (gas/scleral buckle/vitrectomy).
4. [End] Single superior break → pneumatic retinopexy
   Single superior break, clear media, able to maintain positioning → pneumatic retinopexy (outpatient) + laser/cryopexy to seal the break.
5. [End] Complex → vitrectomy ± buckle
   Complex (multiple/inferior breaks, PVR, pseudophakic, posterior breaks) → pars plana vitrectomy (PPV) ± scleral buckle, gas/silicone oil tamponade; young phakic uncomplicated cases may have scleral buckle alone.
6. [End] Tractional/exudative
   Tractional (proliferative diabetic retinopathy) → vitrectomy to relieve traction; exudative → treat the cause (inflammation/tumor/hypertension), usually no reattachment surgery needed.

Source guidelines & references

• Retinal detachment management (AAO posterior segment PPP)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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