Primary Retinal Detachment

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Chapter 10 Retinal Detachment Repair: Outlook for the Future William R. Freeman Due to the pioneering work of many ophthalmologists, including Gonin, Lincoff, and others, the basic pathophysiology of rhegmatogenous retinal detachment has been established. A retinal tear is caused by a vitreous detachment and traction on the retinal tear, and peripheral retina is responsible for fluid currents, which go through the break and detach the retina. More fundamental questions remain to be answered and will have important implications for our ability to detect, prevent, and treat rhegmatogenous retinal detachment and its complications. Many controversies remain regarding surgical repair of this disease. This controversy is complicated due to a lack of prospective randomized clinical trials comparing different methods of Fig. 10.1. Radial sponge has cured a retinal detachment without the need for drainage
194 10 Retinal Detachment Repair: Outlook for the Future Fig. 10.2. Balloon buckle in place closing retinal break treatment. For this reason, much of the debate revolves around theory and philosophy, not hard clinical data. There is little doubt that the most minimal operation that would be highly effective would be the procedure of choice. Highly effective should include minimal complications and inconveniences, such as the induction of refractive error (Lincoff, Kreissig) [1]. In this regard, the classical radial sponge (Fig. 10.1) or the balloon buckle (Fig. 10.2) remains the gold standard for many, due to the extraocular nature of the surgery and low complication rate. These procedures shared in common extraocular placement of a bulky device,which reapposes or nearly apposes the neurosensory retina and retinal pigment epithelium/choroicapillaris. By bringing these two layers in close proximity, the rate of fluid flow under the retina is limited and the pumping action of the pigmented epithelium overcomes the leakage of fluid through the retinal tear; thus the retina reattaches. The use of retinopexy is a backup procedure to further prevent fluid leakage, causing a permanent scar or adhesion of the two layers (Figs. 10.3 and 10.4). Unfortunately, segmental buckling is not
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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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Table 6.4. Visual acuity at 2 years
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Page 148 and 149: 140 Probably, the future question n
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Page 154 and 155: 146 7 Pharmacological Approaches to
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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
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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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