Primary Retinal Detachment

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Conclusion 169 vitrectomy and search for the retinal break at the operating table, where the wage rate is 37% higher (Medicare fees from New York, New Jersey, Connecticut). If one does not find the break, a surgeon might be inclined to do a peripheral laser barricade augmented by an encircling band. The barrier operation, which was disappearing near the end of the twentieth century, is returning as a prophylactic supplement to primary vitrectomy and pneumatic retinopexy [54]. Peer Review A third factor operating against the buckle operation for primary detachment, beyond the lack of training and the limit of reimbursement for the time spent, is the absence of peer review. Preoperative surgical rounds, where the surgical plan for retinal detachment was open for review, suggestion, criticism, and even censure, have disappeared; with 1-day surgery, there is not time for it. The surgeon admits his patient on the day of the operation with as much preparation as his schedule allowed, and, when the patient leaves the hospital later in the day with the eye filled with gas, there is no opportunity to evaluate the effort by his or her peers. Conclusion The proponents of primary vitrectomy claim that the final attachment rate after multiple procedures is 99%. In the series that we examined, it was 97%, equal to that of buckling. This is reassuring. They dismiss the morbidity of multiple operations and regard the frequent provocation of cataract as acceptable. We do not think it is possible to counteract the change in the treatment of retinal detachment. Perhaps market forces will relax, and peer review will return, or maybe new and less morbid methods to attach the retina will be invented. Admittedly, the incidence of
170 second surgery and PVR were beginning to diminish in the most recent of the case series that we examined, and perhaps a way to reduce the incidence of postoperative cataract will develop. If not, maybe in another 50 years, someone will rediscover the scleral buckle. � Acknowledgements. This study was supported by The Edward L. Grayson Retinal Research Fund, West Orange, NJ; Señora Salua H. Kuri, Mexico City, Mexico; Caroline H. Newhouse and the Newhouse Foundation, New York, USA. The authors have no proprietary interest in any of the aspects of this study. References 8 Systematic Review of Efficacy and Safety of Surgery 1. Oshima Y,Yamanishi S, Sawa M, Motokura M, Harino S, Emi K (2000) Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment. Jpn J Ophthalmol 44:538–549 2. Pournaras CJ, Kapetanios AD (2003) Primary vitrectomy for pseudophakic retinal detachment: a prospective non-randomized study. Eur J Ophthalmol 13:298–306 3. Tanner V, Minihan M, Williamson TH (2001) Management of inferior retinal breaks during pars plana vitrectomy for retinal detachment. Br J Ophthalmol 85:480–482 4. Miki D, Hida T, Hotta K, Shinoda K, Hirakata A (2000) Comparison of scleral buckling and vitrectomy for superior retinal detachmentcaused by flap tears (in Japanese). Nippon Ganka Gakkai Zasshi 104: 24–28 5. Speicher MA, Fu AD, Martin JP, von Fricken MA (2000) Primary vitrectomy alone for repair of retinal detachments following cataract surgery. Retina 20:459–464 6. Pournaras CJ, Donati G, Sekkat L et al (2000) Pseudophakic retinal detachment:treatment by vitrectomy and scleral buckling. Pilot study (in French). J Fr Ophtalmol 23:1006–1011 7. Gastaud P, Rouhette H, Negre F et al (2000) Place of “exploratory vitrectomy” in the treatment of retinal detachment without proliferative vitreoretinopathy (in French). J Fr Ophtalmol 23:482–487
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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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114 a 6 Minimal Segmental Buckling
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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
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Page 170 and 171: Materials and Methods 163 Table 8.2
Page 172 and 173: Discussion 165 30% 25% 20% 15% 10%
Page 174 and 175: Discussion 167 Fig. 8.2. The small
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
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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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