Primary Retinal Detachment

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184 9 Repair of Primary Retinal Detachment As a result, minimal segmental buckling with sponge(s) or a balloon without drainage represents a second option for repair of a primary retinal detachment in use at the beginning of the twentyfirst century (Fig. 9.5). Apart from these two options for closing the leaking break with a circular barrier (cerclage) or a segmental buckle (sponge or balloon) limited to the break, both of which are extraocular, two options for an intraocular approach developed. An intraocular gas bubble to tamponade a leaking break was introduced – now for the second time. Instead of air, SF6 was injected by Norton and Lincoff [20, 21]. This technique required drainage of subretinal fluid with its complications. In 1979, Kreissig [22] applied – for the first time – intraocular SF6, an expanding gas, without prior drainage in selected detachments. The procedure was named the expanding-gas operation without drainage. However, an increased rate of postoperative proliferative vitreoretinopathy (PVR) caused Kreissig to reserve intraocular gas for problematic breaks not suitable for buckling. Subsequently to reduce the morbidity of intraocular gas, Kreissig developed the balloon-gas procedure which enables to inject primarily a larger bubble of a gas with a shorter intraocular duration [23]. To close a leaking break with a gas bubble and without prior drainage was introduced again – for the second time – by Hilton [24] and simultaneously by Dominguez [25] in 1986. Hilton called the procedure pneumatic retinopexy which represents a third option for repair of a primary retinal detachment in use at the beginning of the twenty-first century (Fig. 9.6a). When supplemented by 360° barrier coagulations, it is no longer a procedure limited to the break (Fig. 9.6b) [26]. Pneumatic retinopexy has become a popular procedure, despite the fact that it has a greater morbidity for closing the leaking break than minimal segmental buckling without drainage. Its popularity is due to its relative simplicity. To reduce the postoperative complications of intraocular gas, a vitrectomy was added [27]. The rationale was that a vitrectomy
Repair of Primary Retinal Detachment 185 a b Fig. 9.5. Minimal segmental buckling without drainage and coagulations limited to the tear for repair of the detachment in Fig. 9.1. The buckle is obtained by a radial sponge (a) or by a temporary balloon beneath the tear (b). After withdrawal of the unsutured parabulbar balloon (after 1 week), the tear will be only secured by coagulations
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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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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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Page 142 and 143: 134 6 Minimal Segmental Buckling Wi
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 172 and 173: Discussion 165 30% 25% 20% 15% 10%
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
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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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