Primary Retinal Detachment

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26 2 Prophylaxis in Fellow Eye of Primary Retinal Detachment broad assumptions which were as follows: (1) the occurrence of bilateral retinal detachment was thought to be in the range of 20–50% of patients who had suffered a primary detachment, (2) the associated pre-existing “suspect” retinal lesions were thought to represent the precursor sites from which retinal tears would later arise, and (3) the pretreatment of these pre-existing visible retinal lesions was thought to prevent later retinal tears and detachment. This thinking, which was believed to justify the concept of “prophylactic”treatment, was greatly advanced and crystallized in the 1950s by the bringing together of two important developments in ophthalmology. The first of these was the popularization by Schepens [1] of a definitive method of retinal examination, using binocular indirect ophthalmoscopy combined with simultaneous localized scleral indentation. This method opened the possibility of examining in detail all areas of the retina in multiple, stereoscopically viewed images. This development was a vast advance over previous methods and eventually led to the accurate characterization of various peripheral retinal lesions and to the quantitative collection of natural history data that had previously remained unknown. The second very significant event that influenced the thinking regarding “prophylactic” treatment was the invention by Meyer- Schwickerath [2] of an effective method to deliver controlled photocoagulation energy to the retina to produce discrete retinal burns which later became converted into small scars. The concurrence of these two events had the momentous effect of opening up the vastly improved possibilities of finding and of treating many peripheral retinal lesions which heretofore had remained hidden. In a relatively short time, as the result of very successful promotion and distribution, photocoagulation instruments became available throughout the world. It is very easy to understand, based on the uncritical acceptance of the previously mentioned three assumptions, that a new “standard of care” soon emerged throughout the world that prevention of retinal detach-
2 Prophylaxis in Fellow Eye of Primary Retinal Detachment 27 ment could (and should) be achieved by systematic “prophylactic” treatment of various pre-existing asymptomatic retinal lesions. Two large long-term surveys of reports in the literature, purporting to substantiate the correctness of this view were published by Meyer-Schwickerath and Fried in 1980 [3] and by Haut et al. in 1988 [4] all of whom were staunch advocates of this standard of care and believed that it provided substantial success in achieving the goal of preventing retinal detachment. Both surveys revealed that there was a residual risk of retinal detachment, even after those attempts to prevent it, amounting to 5% in the first report [3] and 2–5.5% in the second report [4], depending on the modality used. Eventually, however, various reports began to appear which tended to agree in showing that the three underlying assumptions which formed the basis of the new standard of care were not accurate. With regard to the first assumption, the bilaterality of retinal detachment had been considerably overestimated, and instead of being 20–50%, was in the range of 6–11% [5–13] (Table 2.1). With regard to the second assumption, it has been reported that 72% of new symptomatic retinal tears occur in retinal areas that appear clinically normal [14]; and, in a large autopsy study of eyes Table 2.1. Incidence of bilateral retinal detachment Author(s) Incidence (%) Toernquist 1963 [5] 11.2 Edmund 1964 [6] 9.3 Boeke 1966 [7] 6.6 Michaelson et al. 1969 [8] 10.9 Davis et al. 1974 [9] 7.9 Bleckman and Engels 1975 [10] 8.1 Haut and Massin 1975 [11] 11.4 Laatikainen and Harju 1985 [12] 10.0 Toernquist et al. 1987 [13] 11.0
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 26 and 27: 16 ion [147]. Perfluorocarbon liqui
Page 38 and 39: 28 2 Prophylaxis in Fellow Eye of P
Page 42 and 43: 32 found that eyes with pre-existin
Page 46 and 47: 36 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
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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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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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