Primary Retinal Detachment

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188 might eliminate traction on the break and reduce postoperative anterior and posterior vitreous proliferation. The analysis in Chap. 8 indicates that this aim has not been achieved; nevertheless, the procedure is increasingly applied. Primary vitrectomy has become a fourth option for repair of a primary retinal detachment at the beginning of the twenty-first century (Fig. 9.7). When supplemented by extensive barrier coagulations and a cerclage, it is no longer a procedure limited to the break. Conclusion 9 Repair of Primary Retinal Detachment In the beginning of the twenty-first century, the present state-ofthe-art for repair of a primary retinal detachment has reverted from a local to a barrier concept of treatment – as has happened several times during the past 75 years. External buckling: local buckles with coagulations limited to the break (Fig. 9.5a, b) are becoming replaced by local buckles supplemented by an encircling band with extended coagulations (Fig. 9.4a, b), applied as a barrier against redetachments. The same applies to pneumatic retinopexy: the primary intent to limit treatment to the area of the tear (Fig. 9.6a) is given up – again – in favour of a barrier concept by applying 360° of coagulations (Fig. 9.6b). A similar trend is becoming apparent with primary vitrectomy: initially aimed at removing traction on the tear and limiting the coagulations to the area of the tear (Fig. 9.7a), the procedure has been extended by a circular barrier of coagulations with an encircling band supplemented by a local buckle beneath the tear to prevent redetachments (Fig. 9.7b). Of the four surgical techniques in use at present for repair of a primary rhegmatogenous retinal detachment, two are extraocular operations (minimal segmental buckling with sponges or a balloon without drainage and cerclage with drainage) and two are intra-
References 189 ocular (pneumatic retinopexy and primary vitrectomy). To succeed with any of these methods, the leaking break still has to be found and sealed. Therefore, finding and closing the retinal break in a rhegmatogenous retinal detachment will continue to be the primary purpose of any surgical effort. With any of the four presently applied surgical techniques, retinal attachment can result in 94–99% of primary rhegmatogenous retinal detachments, but with different degrees of morbidity. At this point in time, we must wait to see which of these four procedures or their extended modifications will prevail or whether a better and less morbid method for repair of retinal detachment will evolve. References 1. Lincoff H, Kreissig I (2000) Changing patterns in the surgery for retinal detachment. Klin Monatsbl Augenheilkd 216:352–359 2. Gonin J (1930) Le traitement opératoire du décollement rétinien. Conférence aux journées médicales de Bruxelles. Bruxelles-Médical 23:No. 17 3. Guist E (1931) Eine neue Ablatiooperation. Ztsch Augenheilk 74: 232–242 4. Lindner K (1931) Ein Beitrag zur Entstehung und Behandlung der idiopathischen und der traumatischen Netzhautabloesung. Graefes Arch Ophthalmol 127:177–295 5. Safar K (1932) Behandlung der Netzhautabhebung mit Elektroden fuer multiple diathermische Stichelung. Dtsch Ophthalmol Ges 39: 119 6. Rosengren B (1938) Ueber die Behandlung der Netzhautabloesung mittelst Diathermie und Luftinjektion in den Glaskoerper. Acta Ophthalmol 16:3–42 7. Schepens CL (1953) Prognosis and treatment of retinal detachment. The Mark J Schoenberg Memorial Lecture.A review by Kronenberg B, New York Society for Clinical Ophthalmology. Am J Ophthalmol 36: 1739–1756 8. Arruga MH (1958) Le cerclage equatorial pour traiter le decollement retinien. Bull Soc Franc Ophtal 71:571–580
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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
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130 Choroidals In 4 of the 1,462 de
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Table 6.4. Visual acuity at 2 years
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Page 144 and 145: 136 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 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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