Primary Retinal Detachment

42
3 Encircling Operation with Drainage for Primary Retinal Detachment
Kreissig, who drained 98.7% of cases from 1966 to 1969, reported
intraocular hemorrhage (smallest or larger) in 15.6% [28]. In
1975, Blagojevic, who drained 96% of cases, found intraocular
hemorrhages in 16% and retinal incarceration in 1% [29]. Huebner,
who drained 89% of cases, found intraocular hemorrhages in 6.9%
and retinal incarceration in 0.7% [30]. Also in 1975, Spalter reported
iatrogenic retinal holes related to drainage that had occurred in
2.3–14.8%, often accompanied by vitreous loss, depending on the
technique used [31].
Improvements in the technique of drainage included transillumination
of the choroid to identify large vessels, diathermy [32],
puncturing away from vortices and long posterior ciliary vessels
[29], using the microscope [33], using traction [31], or incomplete
drainage [34].
All of the reports on drainage and its complications are retrospective.
It is hard to imagine a detailed report about the exact submacular
distribution of blood in the operative note. Yet, as Cibis
wryly remarked,“As you all know, surgeons, as a rule, do not report
their complications and mistakes unless they are related to a technique
devised by another surgeon” [25]. Nevertheless, reports of
failures exist, relating failure to complications of drainage in a
majority of cases [35]. Underreporting of less than a “major hemorrhage”
is likely. Blagojevic, who noted intraocular hemorrhages
in 16% wrote:“It is important to stress that [the intraocular hemorrhages]
were never widespread, and that they did not unfavorably
affect the results of the operation. Hemophthalmus and choroidal
hematoma were not noticed” [29]. There have been many modifications
of the drainage technique [27–34], attesting to the difficulty
of producing a bloodless perforating injury in a highly perfused,
inflamed and hypotonous vascular layer. Added risks over the past
seven decades have been increasing patient age and widespread
use of anticoagulants. Possibly, poor visual acuity found after
“scleral buckling” might be related to underreported complications
of drainage and layers of barely visible subretinal blood
under the fovea (Fig. 3.5).