Primary Retinal Detachment

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182 9 Repair of Primary Retinal Detachment designed to fit the tear combined with coagulations limited to the tear or extending over 360° (Fig. 9.4). More retinas were attached – more than 80%. The modified cerclage with drainage represents one of the four techniques still in use for repair of a primary retinal detachment at the beginning of the twenty-first century (Fig. 9.4). Drainage, however, required by this technique, has complications. In 1953, Custodis [9] limited the treatment – now for the third time – to the area of the leaking break, but – for the first time – omitted drainage of subretinal fluid. This exceptional technique was nearly abandoned, not because it did not work, but because of unexpected postoperative complications caused by diathermy and the polyviol plombe, which Custodis compressed over full-thickness and diathermized sclera, which sometimes caused scleral necrosis. As a result, the technique was abandoned in the United States and in Europe. Lincoff in New York, who was convinced of the logic and simplicity of the Custodis procedure, made the operation acceptable by replacing diathermy with cryopexy [10, 11] and the polyviol plombe with the tissue-inert silicone sponge [12]. In the following years, this technique was further refined by smaller segmental buckles that were positioned more precisely [13] and by replacing the sclerafixated sponge with a temporary balloon buckle [14, 15] that was not sutured onto sclera. The balloon operation was suitable for detachments with a single break. This minimal segmental buckling with sponges or a balloon represents an extraocular approach, limited, again, to the area of the leaking break. However, the “conditio sine qua non” for a spontaneous attachment without drainage was that all of the leaking breaks had to be found and tamponaded adequately. Otherwise, the disappearance of subretinal fluid would not occur. Finding all the breaks was helped by the development of binocular indirect ophthalmoscopy, biomicroscopy with contact lenses, the 4 Rules to find the break in a primary detachment [16, 17], and the 4 Rules to find the break in an eye up for reoperation [18, 19].
Repair of Primary Retinal Detachment 183 a b Fig. 9.4. Modified cerclage: Encircling silicone band with a local buckle beneath the tear and drainage for repair of the detachment in Fig. 9.1. With coagulations limited to the area of the tear (a) or with coagulations extended for 360° (b)
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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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Chapter 4 Pneumatic Retinopexy for
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Technique 57 Case Selection Proper
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Technique 59 Table 4.1. Gas charact
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Technique 61 solution; however,thes
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Technique 63 gas reflux. Following
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Complications: Prevention and Manag
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New Possibilities 67 ing on type an
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Results 69 Table 4.7 (continued) Au
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Discussion 71 surgical failures. Fa
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Discussion 73 Disadvantages of PR A
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References 75 situations, then to p
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References 77 24. Tornambe PE, Hilt
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References 79 51. Pournaras CJ, Don
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Chapter 5 Vitrectomy for the Primar
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Indications 83 Table 5.1. Indicatio
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Indications 85 Fig. 5.2. The vitreo
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Surgical Technique 87 vitrectomy an
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Outcomes 89 will be visible under a
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Outcomes 91 almost no persistent su
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References 93 7. Heimann H, Bornfel
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96 6 Minimal Segmental Buckling Wit
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98 6 Minimal Segmental Buckling Wit
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100 the operating table with the re
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102 6 Minimal Segmental Buckling Wi
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106 a b 6 Minimal Segmental Bucklin
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114 a 6 Minimal Segmental Buckling
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122 c d 6 Minimal Segmental Bucklin
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124 c Fig. 6.14c 6 Minimal Segmenta
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Table 6.1. Preoperative characteris
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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 142 and 143: 134 6 Minimal Segmental Buckling Wi
Page 148 and 149: 140 Probably, the future question n
Page 154 and 155: 146 7 Pharmacological Approaches to
Page 160 and 161: 152 heparin was published in eyes u
Page 162 and 163: 154 search for compounds with hepar
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 192 and 193: 186 a b 9 Repair of Primary Retinal
Page 194 and 195: 188 might eliminate traction on the
Page 198 and 199: Chapter 10 Retinal Detachment Repai
Page 200 and 201: Retinal Detachment Repair: Outlook
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
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Primary Retinal Detachment

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