Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
110<br />
6 Minimal Segmental Buckling With Sponges and Balloons<br />
Limits of Minimal Segmental Buckling Without Drainage<br />
There are limits to minimal segmental buckling; however, more<br />
than 90% of rhegmatogenous detachments can be treated by extraocular<br />
minimal buckling alone – the remaining 10% can be divided<br />
into three major categories.<br />
First Category of Difficult <strong>Detachment</strong>s<br />
In this type of detachments, the limits of the minimal procedure<br />
are exceeded if the tears are posterior (in about 1%),multiple at different<br />
latitude (in 2–3%), or with a circumferential extent greater<br />
than 70° (in 1–2%). A tamponade with an expanding gas bubble<br />
without drainage represents the next level of a minimal surgery for<br />
these conditions, but it requires an intraocular injection. Consequently,<br />
in this first category, a gas tamponade will suffice.A vitrectomy<br />
will be needed for the rare situation of a giant tear of less than<br />
or equal to 150° with an overhanging flap or, as in some hands, if<br />
the tear is greater than 90°.<br />
Second Category of Difficult <strong>Detachment</strong>s<br />
These are detachments with local vitreous traction that caused the<br />
redetachment of a horseshoe tear that had been buckled or detachments<br />
with proliferative vitreoretinopathy in more than two quadrants.<br />
In these detachments, a primary vitrectomy may be indicated.<br />
However, it is not indicated per se if the starfolds are more than<br />
1 clock hour from the tear to be buckled. In these difficult detachments,<br />
buckling first is advisable (Fig. 6.8) [33–35]. However, if one<br />
decides upon a vitrectomy, it has to be combined with a meticulous<br />
removal of proliferative preretinal membranes and the anterior vitreous.<br />
Why? Because the additional gas tamponade, combined with<br />
the vitrectomy, can provoke anterior vitreoretinal proliferation.