Primary Retinal Detachment

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Discussion 165 30% 25% 20% 15% 10% 5% 0% The odds ratio of the pooled procedures, i.e., 3384 intraocular gas operations and vitrectomies versus 1854 extraocular sponge and balloon buckles, for the risk of second surgery, was: (680/2704) 08 = 2.5 to 1 (107/1684) and for PVR: (187/2927) 07 = 6 to 1 . (17/1685) Discussion second surgery PVR pneumatic retinopexy vitrectomy buckling Fig. 8.1. Pool risk of second surgery and proliferative vitreoretinopathy (PVR) In the latter half of the twentieth century, the buckle operations invented by Charles Schepens in 1951 [63] and Ernst Custodis in 1953 [64] were modified and refined. Diathermy was replaced with cryo-
166 8 Systematic Review of Efficacy and Safety of Surgery pexy; scleral resections and implants were replaced with explants sutured over full thickness sclera [65, 66]. Extensive circumferential buckles and encircling operations – barrier procedures that were intended to wall away undetected breaks in the periphery – were replaced with segmental buckles confined to the breaks. The undetected break was less frequent because preoperative indirect ophthalmoscopy was augmented by binocular microscopy of the retinal periphery through the mirrors of the Goldmann lens. Closing the retinal breaks became the sole surgical problem; the extent of the detachment was a lesser factor. If the breaks were effectively buckled, the large detachment would attach without drainage after only a few additional hours (Fig. 8.2). Not draining subretinal fluid was increasingly adopted. At the New York Hospital, the incidence of not draining rose from 50% to 90% in the course of the first 1,000 cases after the senior author (HL) met with Ernst Custodis and adopted his method [67]. Diminished morbidity was the Holy Grail. The external buckle operation with a segmental sponge and without perforation for drainage had no intraocular complications and only infrequent extraocular ones. There was a buckle infection initially of 3% that dropped to 1% with the development of the closed-cell sponge and the use of parabulbar antibiotic [68]. Diplopia might occur if a sponge intruded on a rectus muscle. The substitution of a temporary balloon for breaks beneath a rectus muscle eliminated postoperative diplopia because, within hours after the balloon was withdrawn, the muscle functioned normally again [55]. A second operation after the sponge procedure was required in 11% and after the balloon procedure in 7%. Failure with either the sponge or the balloon was due to an undiscovered break or an inaccurately placed sponge or balloon. Final attachment for the sponge operation after a second buckle was 97% and for the balloon was 99%. Less than 2% developed PVR postoperatively after either procedure. The low incidence of PVR was a positive affect of diminished operative trauma. The greater incidence of PVR as we knew it in prior years was iatrogenic, a product of trauma inflicted by extensive barrier
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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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16 ion [147]. Perfluorocarbon liqui
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26 2 Prophylaxis in Fellow Eye of P
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32 found that eyes with pre-existin
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36 3 Encircling Operation with Drai
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Chapter 4 Pneumatic Retinopexy for
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Technique 57 Case Selection Proper
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Technique 59 Table 4.1. Gas charact
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Technique 61 solution; however,thes
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Technique 63 gas reflux. Following
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Complications: Prevention and Manag
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New Possibilities 67 ing on type an
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Results 69 Table 4.7 (continued) Au
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Discussion 71 surgical failures. Fa
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Discussion 73 Disadvantages of PR A
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References 75 situations, then to p
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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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108 a b 6 Minimal Segmental Bucklin
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Page 136 and 137: Table 6.3. Final attachment after m
Page 138 and 139: 130 Choroidals In 4 of the 1,462 de
Page 140 and 141: Table 6.4. Visual acuity at 2 years
Page 148 and 149: 140 Probably, the future question n
Page 154 and 155: 146 7 Pharmacological Approaches to
Page 160 and 161: 152 heparin was published in eyes u
Page 162 and 163: 154 search for compounds with hepar
Page 168 and 169: Chapter 8 Systematic Review of Effi
Page 170 and 171: Materials and Methods 163 Table 8.2
Page 174 and 175: Discussion 167 Fig. 8.2. The small
Page 176 and 177: Conclusion 169 vitrectomy and searc
Page 178 and 179: References 171 8. Brazitikos PD, D
Page 180 and 181: References 173 34. Gunduz K, Gunalp
Page 182 and 183: References 175 63. Schepens CL (195
Page 184 and 185: 178 9 Repair of Primary Retinal Det
Page 186 and 187: 180 a b Fig. 9.3a,b. Legend see pag
Page 192 and 193: 186 a b 9 Repair of Primary Retinal
Page 194 and 195: 188 might eliminate traction on the
Page 198 and 199: Chapter 10 Retinal Detachment Repai
Page 200 and 201: Retinal Detachment Repair: Outlook
Page 212 and 213: References 207 It is impossible to
Page 214 and 215: 210 C Campbell 7 case selection 57,
Page 216 and 217: 212 M Machemer 13 macular - complic
Page 218 and 219: 214 retinal - detachment - - bilate
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Primary Retinal Detachment

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