46 3 Encircling Operation

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46 3 Encircling Operation with Drainage for Primary Retinal Detachment Double patching and bed rest were encouraged whenever possible. After localization of all breaks and cryopexy, 5-mm sponges were applied in 82%. They were placed radially in 49% and circumferentially in 33%. The primary success rate was 87%. Reasons for Modification As indicated above, the success rate depends on case selection, length of follow-up, whose cases they are, who evaluates them, etc. The impetus for change in the latter series was the unavoidable morbidity associated with encircling and drainage. In order to make sure that the overall success rate corresponded to the published norm of 80–90%, modifications occurred gradually – first by tying the band loosely, then by omitting it. Modifications were also made by shortening the circumferential 7-mm explant and finally by just buckling the breaks, preferably in a radial orientation. Fewer and fewer cases were drained, sometimes at the cost of sleep. This experience somewhat parallels the trend described by Lincoff,who drained 48% of cases in 1963 and only 13% by 1971 [39], or by Kreissig who drained almost all cases in 1966, 6% of cases in 1972 [40] and none in 1992 [36]. The reasons for drainage were (1) giant tears, (2) severe preretinal retraction, (3) uncertain localization of the break, (4) defective choroid, (5) thin sclera, or (6) glaucoma [39]. Reasons 1–3 might be managed by vitrectomy techniques today including encircling with the ubiquitous 3.5-mm band, which reduces indications for drainage. Are Encircling and Drainage Still Worth Doing? As every detachment surgeon knows,there are detachments of good and of poor prognosis. Good prognostic signs include: fewer breaks, less extensive area of detachment, shallow detachments and
Are Encircling and Drainage Still Worth Doing? 47 Fig. 3.7. A detachment with a good prognosis. A one-quadrant detachment, one break, in a 50-year-old male patient, flattened with bed rest. A radial 5-mm sponge was placed, followed by laser phakic status (Fig. 3.7). Indicators of poor prognosis include: many breaks, undetectable breaks, a large area of detachment, bullous detachment, aphakic/pseudophakic status and proliferations of vitreous and retina (Fig. 3.8). Not surprisingly, these indicators are similar in the literature on both buckling and pneumatic retinopexy [16]. Minimal procedures are appropriate to repair more favorable cases, whereas procedures associated with higher morbidity are reserved for the complex case. Schepens corroborated this finding. “The circling element was at first used in cases with an unfavorable prognosis.As experience with this procedure increased it was used on more and more favorable cases and it was found to be the most dependable operation”[2]. This misconception, that if it is good for complicated cases it is even better for uncomplicated ones, has proved to be a common reasoning in clinical practice, as observed by Lincoff and Kreissig [41].
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Ingrid Kreissig (Ed.) Primary Retin
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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 36 and 37: 26 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
Page 88 and 89: References 79 51. Pournaras CJ, Don
Page 90 and 91: Chapter 5 Vitrectomy for the Primar
Page 92 and 93: Indications 83 Table 5.1. Indicatio
Page 94 and 95: Indications 85 Fig. 5.2. The vitreo
Page 96 and 97: Surgical Technique 87 vitrectomy an
Page 98 and 99: Outcomes 89 will be visible under a
Page 100 and 101: Outcomes 91 almost no persistent su
Page 102 and 103: References 93 7. Heimann H, Bornfel
Page 104 and 105: 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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Primary Retinal Detachment

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