Prophylaxis of retinal detachment.

Prophylactic treatment of retinal breaks can only be justified if the risk of complications from treatment is lower than the risk of breaks leading to clinical retinal detachment. Recommendations for prophylaxis should be based on results from valid controlled studies and not merely on traditional high-risk associations between certain risk factors and clinical retinal detachment. Present evidence supports prophylactic treatment of all symptomatic tractional tears; and is suggestive for the treatment of large, symptomatic operculated tears, high-risk fellow eyes of nontraumatic giant retinal breaks, retinal breaks with subclinical retinal detachments threatening progression, and retinal breaks before cataract surgery. Support for prophylactic treatment of asymptomatic retinal breaks in aphakic and pseudophakic eyes with or without an intact posterior capsule is at best, equivocal. Asymptomatic retinal breaks in phakic eyes with lattice degeneration, high myopia, and fellow eye detachments show no significant benefit from prophylaxis and should be followed without treatment.