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Retinal Detachment Repair: Outlook for the Future 203 Fig. 10.14. Stereo photograph of old giant retinal tear with cyst. Fellow eyes are at high risk trial techniques. The network of academic collaborations will be able to be formalized, and individual physicians will be able to collaborate seamlessly. Clinical science will also advance as we learn more about genetics and other cofactors that predispose to retinal detachment. Our knowledge of who is at high risk for retinal detachment remains rudimentary. We know that fellow eyes are at risk, particularly in certain conditions (Fig. 10.14); but there remains great controversy as to the role of prophylaxis of peripheral retinal lesions that may be related to retinal detachment. Clearly, as we learn more about risk factors, the role of different types of prophylaxis will become better understood. This, in conjunction with more facile ways to perform clinical trials and surveys, will allow preventive treatment algorithms to evolve. The pioneering work of Sawa and Tano in Osaka has shown us that it is not instrumentation of the vitreous itself, but infusing of fluids that is likely the cause of nuclear sclerosis and cataract induction after vitrectomy [8]. As vitreous surgery is applied to eyes with relatively good visual potential, the side effect of cataract is more clinically important. Our indications for vitrectomy in the repair of retinal detachment and for other diseases may expand considerably if we can avoid cataract formation in these eyes.
204 10 Retinal Detachment Repair: Outlook for the Future Fig. 10.15. Proliferative vitreoretinopathy Finally, let us not forget drug treatment and pharmacotherapy in the area of retinal detachment. One of the main nemeses of retinal detachment surgeons is proliferative vitreoretinopathy (PVR) (Fig. 10.15). This is the result of a biological process gone awry. Cellular elements already in the eye and, in some cases in the blood, proliferate, lay down collagen, and cause collagen contraction. This biological process results in membrane formation, recurrent retinal detachment, and macular pucker. There has been widespread study of the classical antiproliferatives to reduce the risk of PVR or to limit it. These drugs, such as 5FU and Daunomycin, are intrinsically toxic. We will soon be using the techniques of molecular biology and intelligent drug design to create more sophisticated anti-proliferative drugs. Such drugs may take the shape of the hammerhead ribozyme, which cleaves mRNA involved in proliferation and other processes (Fig. 10.16). These types of drugs are similar to antisense, but unlike antisense are recycled intracellularly [9]. Thus, they may be able to be applied into the eye and remain active in cells for months or longer. There will be other ways to block this biological process, including acting on inflammation, proliferative pathways, and cytokine pathways. The
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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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140 Probably, the future question n
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146 7 Pharmacological Approaches to
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148 7 Pharmacological Approaches to
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Page 170 and 171: Materials and Methods 163 Table 8.2
Page 172 and 173: Discussion 165 30% 25% 20% 15% 10%
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Page 212 and 213: References 207 It is impossible to
Page 214 and 215: 210 C Campbell 7 case selection 57,
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Page 218 and 219: 214 retinal - detachment - - bilate
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Primary Retinal Detachment

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