Primary Retinal Detachment

More documents

Recommendations

Info

Outcomes 91 almost no persistent subretinal fluid involving the macula. Thus, the recovery of macular function starts immediately postoperatively. Choroidal detachment is rarely seen in vitrectomized eyes. Endolaser photocoagulation is more comfortable for the patient and may cause less surgically-induced inflammation compared with cryotherapy. If a scleral buckle is used in conjunction with vitrectomy, it tends to be a smaller buckling element, especially with large posterior retinal tears. In pseudophakic eyes, there is less change in postoperative refractive error when no scleral buckle is used. The complications of vitrectomy may affect the visual and anatomic outcome. The possibility of iatrogenic retinal breaks as a result of cutting near mobile retina or from vitreous incarceration at sclerotomy sites increases the risk of failure. A large gas bubble may be associated with glaucoma or with iris capture of an intraocular lens. Unexplained visual field defects may also occur after vitrectomy. Rarely, a retinal fold that involves the macula is seen postoperatively. The patient complains of marked distortion. Endophthalmitis is a rare but devastating complication. In phakic eyes, the postoperative progression of nuclear cataract may be the single reason that vitrectomy is not recommended routinely for every retinal detachment. In a young patient with a clear lens in the fellow eye, the loss of accommodation resulting from pseudophakia can be quite disabling. Thus, whenever possible, it is preferable to use an operation that will not increase the rate of cataract progression. There are also economic considerations that may play a role in the choice between vitrectomy and scleral buckling as the primary treatment for retinal detachment. The cost of supplies for a scleral buckling procedure is significantly less than that of a vitrectomy. If cataract surgery is also required later, the cost difference is multiplied. The rehabilitation time is increased after vitrectomy compared with scleral buckling. In general, most of my patients are able to return to work 1 week after scleral buckling. After vitrectomy, most patients are incapacitated for 2–4 weeks because of head positioning and inability to drive. There is a prolonged
92 5 Vitrectomy for the Primary Management of Retinal Detachment recovery time, with lengthened disability. While these factors might seem small for the individual case, it is estimated that up to 30,000–50,000 retinal detachments are treated annually in the United States. Further data will be required to define the role of vitrectomy for the management of uncomplicated retinal detachments. In particular, these studies should provide strong clinical evidence for situations where the benefits from vitrectomy are superior to scleral buckling. At the present time, the main limitation for vitrectomy in phakic eyes is the progression of nuclear cataract. Until there are better treatments developed to prevent this complication, scleral buckling remains the main treatment modality for most retinal detachments with vitrectomy as an adjunct for more complex cases. References 1. Lincoff H, Baras I, McLean J (1965) Modifications to the Custodis procedure for retinal detachment. Arch Ophthalmol 73:160–163 2. Kreissig I (2000) A practical guide to minimal surgery for retinal detachment: volume 1. Diagnostics – segmental buckling without drainage – case presentations. Thieme Stuttgart, New York, pp 1–300 3. Kreissig I (2000) A practical guide to minimal surgery for retinal detachment: volume 2. Temporary tamponades with balloon and gases without drainage – reoperation – case presentations. Thieme Stuttgart, New York, pp 1–368 4. Cousins S, Boniuk I, Okun E, Johnston GP, Arribas NP, Escoffery RF, Grand MG, Olk RJ, Schoch LJ (1986) Pseudophakic retinal detachments in the presence of various IOL types. Ophthalmology 93:1198– 1208 5. McHugh D, Wong D, Chignell A, Leaver P, Cooling RJ (1991) Pseudophakic retinal detachment. Graefes Arch Clin Exp Ophthalmol 229:521–525 6. Minihan M, Tanner V, Williamson TH (2001) Primary rhegmatogenous retinal detachment: 20 years of change. Br J Ophthalmol 85: 546–548
Page 2 and 3:
Ingrid Kreissig (Ed.) Primary Retin
Page 4 and 5:
Professor Dr. med. Ingrid Kreissig
Page 6 and 7:
Contents 1 The History of Retinal D
Page 8 and 9:
List of Contributors Gary W. Abrams
Page 10 and 11:
List of Contributors XI Hermann D.
Page 12 and 13:
2 Helmholz in 1850 made an accurate
Page 14 and 15:
4 (vitreous, gelatin) into the ante
Page 16 and 17:
6 with scleral resection that set t
Page 18 and 19:
8 ditis [72-74].Temperatures up to
Page 20 and 21:
10 1 The History of Retinal Detachm
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
16 ion [147]. Perfluorocarbon liqui
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
26 2 Prophylaxis in Fellow Eye of P
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
32 found that eyes with pre-existin
Page 44 and 45:
Page 46 and 47:
36 3 Encircling Operation with Drai
Page 48 and 49:
38 3 Encircling Operation with Drai
Page 50 and 51: 40 3 Encircling Operation with Drai
Page 64 and 65: Chapter 4 Pneumatic Retinopexy for
Page 66 and 67: Technique 57 Case Selection Proper
Page 68 and 69: Technique 59 Table 4.1. Gas charact
Page 70 and 71: Technique 61 solution; however,thes
Page 72 and 73: Technique 63 gas reflux. Following
Page 74 and 75: Complications: Prevention and Manag
Page 76 and 77: New Possibilities 67 ing on type an
Page 78 and 79: Results 69 Table 4.7 (continued) Au
Page 80 and 81: Discussion 71 surgical failures. Fa
Page 82 and 83: Discussion 73 Disadvantages of PR A
Page 84 and 85: References 75 situations, then to p
Page 86 and 87: References 77 24. Tornambe PE, Hilt
Page 88 and 89: References 79 51. Pournaras CJ, Don
Page 90 and 91: Chapter 5 Vitrectomy for the Primar
Page 92 and 93: Indications 83 Table 5.1. Indicatio
Page 94 and 95: Indications 85 Fig. 5.2. The vitreo
Page 96 and 97: Surgical Technique 87 vitrectomy an
Page 98 and 99: Outcomes 89 will be visible under a
Page 102 and 103: References 93 7. Heimann H, Bornfel
Page 104 and 105: 96 6 Minimal Segmental Buckling Wit
Page 106 and 107: 98 6 Minimal Segmental Buckling Wit
Page 108 and 109: 100 the operating table with the re
Page 110 and 111: 102 6 Minimal Segmental Buckling Wi
Page 114 and 115: 106 a b 6 Minimal Segmental Bucklin
Page 122 and 123: 114 a 6 Minimal Segmental Buckling
Page 130 and 131: 122 c d 6 Minimal Segmental Bucklin
Page 132 and 133: 124 c Fig. 6.14c 6 Minimal Segmenta
Page 134 and 135: Table 6.1. Preoperative characteris
Page 136 and 137: Table 6.3. Final attachment after m
Page 138 and 139: 130 Choroidals In 4 of the 1,462 de
Page 140 and 141: Table 6.4. Visual acuity at 2 years
Page 148 and 149: 140 Probably, the future question n
Page 150 and 151:
142 6 Minimal Segmental Buckling Wi
Page 152 and 153:
144 6 Minimal Segmental Buckling Wi
Page 154 and 155:
146 7 Pharmacological Approaches to
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
152 heparin was published in eyes u
Page 162 and 163:
154 search for compounds with hepar
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Chapter 8 Systematic Review of Effi
Page 170 and 171:
Materials and Methods 163 Table 8.2
Page 172 and 173:
Discussion 165 30% 25% 20% 15% 10%
Page 174 and 175:
Discussion 167 Fig. 8.2. The small
Page 176 and 177:
Conclusion 169 vitrectomy and searc
Page 178 and 179:
References 171 8. Brazitikos PD, D
Page 180 and 181:
References 173 34. Gunduz K, Gunalp
Page 182 and 183:
References 175 63. Schepens CL (195
Page 184 and 185:
178 9 Repair of Primary Retinal Det
Page 186 and 187:
180 a b Fig. 9.3a,b. Legend see pag
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
186 a b 9 Repair of Primary Retinal
Page 194 and 195:
188 might eliminate traction on the
Page 196 and 197:
Page 198 and 199:
Chapter 10 Retinal Detachment Repai
Page 200 and 201:
Retinal Detachment Repair: Outlook
Page 202 and 203:
Page 204 and 205:
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
References 207 It is impossible to
Page 214 and 215:
210 C Campbell 7 case selection 57,
Page 216 and 217:
212 M Machemer 13 macular - complic
Page 218 and 219:
214 retinal - detachment - - bilate
show all

Primary Retinal Detachment

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template ?