Primary Retinal Detachment

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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
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Ingrid Kreissig (Ed.) Primary Retin
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Professor Dr. med. Ingrid Kreissig
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Contents 1 The History of Retinal D
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List of Contributors Gary W. Abrams
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List of Contributors XI Hermann D.
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2 Helmholz in 1850 made an accurate
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4 (vitreous, gelatin) into the ante
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6 with scleral resection that set t
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8 ditis [72-74].Temperatures up to
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10 1 The History of Retinal Detachm
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16 ion [147]. Perfluorocarbon liqui
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26 2 Prophylaxis in Fellow Eye of P
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32 found that eyes with pre-existin
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36 3 Encircling Operation with Drai
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38 3 Encircling Operation with Drai
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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
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Page 138 and 139: 130 Choroidals In 4 of the 1,462 de
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142 6 Minimal Segmental Buckling Wi
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144 6 Minimal Segmental Buckling Wi
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146 7 Pharmacological Approaches to
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152 heparin was published in eyes u
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154 search for compounds with hepar
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Chapter 8 Systematic Review of Effi
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Materials and Methods 163 Table 8.2
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Discussion 165 30% 25% 20% 15% 10%
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Discussion 167 Fig. 8.2. The small
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Conclusion 169 vitrectomy and searc
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References 171 8. Brazitikos PD, D
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References 173 34. Gunduz K, Gunalp
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References 175 63. Schepens CL (195
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178 9 Repair of Primary Retinal Det
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180 a b Fig. 9.3a,b. Legend see pag
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186 a b 9 Repair of Primary Retinal
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188 might eliminate traction on the
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Chapter 10 Retinal Detachment Repai
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Retinal Detachment Repair: Outlook
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References 207 It is impossible to
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210 C Campbell 7 case selection 57,
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212 M Machemer 13 macular - complic
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214 retinal - detachment - - bilate
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Primary Retinal Detachment

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