Complications: Prevention

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Complications: Prevention and Management 65 though perhaps not employed by all). If this maneuver fails, the patient should be positioned face down for 6–12 h in order to prevent subretinal migration. During this time period, fish eggs inevitably unite to form the desired, effective single large bubble. Migration of bubbles, especially with expansile gas, into the subretinal space is a substantial complication. This event can be avoided by visualizing the needle within the vitreous cavity prior to injection, achieving a single bubble rather than fish eggs, and by avoiding case selection involving large tears with severe traction. Once gas enters the subretinal space, it may be managed by maneuvering the patient’s head and eye in such a way that it rolls the bubble back through the tear into the vitreous cavity. This is often aided by simultaneous scleral depression. These maneuvers are often unsuccessful, and vitrectomy surgery is necessary for removal. During vitrectomy, the bubble will displace the detached retina anteriorly toward the lens – making infusion line placement, sclerotomy incisions, and instrument entry into the eye problematic. A small retinotomy performed with the vitreous cutter probe located at the most anterior, superior pole of the subretinal bubble usually works well for evacuation. Postoperative The most common postoperative complication of PR is new and/or missed retinal breaks (Table 4.6) [3, 9, 11–18]. Most of these are discovered during the first postoperative month, with between 61% and 86% being identified during this time period [19, 20]. Of new and/or missed breaks, 76% occur in the superior two-thirds of the retina. They almost invariably occur anterior to the equator and are more common in pseudophakic or aphakic eyes [20]. Missed breaks can be avoided by performing a very thorough preoperative retinal examination. The authors have found that a 78D or 90D exam of the peripheral retina is invaluable for discovering small breaks preoperatively. Additionally, cases with media opacities,
66 4 Pneumatic Retinopexy for Primary Retinal Detachment Table 4.6. Postoperative complications New/missed breaks [3, 9, 11–18] 7–33% Break re-opened [13, 15] 0–14% Epiretinal membrane [9, 11–14, 16, 17] 2–11% Proliferative vitreoretinopathy [3, 9, 11–18] 3–13% Cataract [11, 13–15, 17, 18] 0–20% Cystoid macular edema [14, 18] 0–8% Delayed resorption of subretinal fluid [10, 14, 16] 0–6% Macular hole [13, 14, 15, 17] 0–3% Anterior ischemic optical neuropathy [14, 17] 0–2% Endophthalmitis [13]
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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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12 1 The History of Retinal Detachm
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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 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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Page 108 and 109: 100 the operating table with the re
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116 a b 6 Minimal Segmental Bucklin
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118 6 Minimal Segmental Buckling Wi
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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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