Primary Retinal Detachment

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28 2 Prophylaxis in Fellow Eye of Primary Retinal Detachment Table 2.2. Remaining risk of retinal detachment (RD) following “prophylactic” treatment of fellow eyes with predisposing lesions Author(s) Risk of RD (%) Michaelson et al. 1972 [16] 9.1 Morax et al. 1974 [17] 8.6 Dralands et al. 1980 [18] 2.9 Meyer-Schwickerath and Fried 1980 [3] 5.0 Girard et al. 1982, 1983 [19, 20] 4.4 Haut et al. 1988 [4] 2.0–5.5 Folk et al. 1989 [21] 2.9 Table 2.3. Incidence of retinal detachment in fellow eyes of comparison groups of patients with “dangerous” lesions without and with “prophylactic” treatment Author(s) Without Rx (%) With Rx (%) Dralands et al. 1980 [18] 3.7 2.9 Girard et al. 1982, 1983 [19, 20] 0.0 4.4 Folk et al. 1989 [21] 5.1 2.9 with lattice degeneration, 79% of the tears were located in such areas [15]. As for the third assumption, various reports have shown the still remaining rate of detachment following “prophylactic” treatment of fellow eyes to be from 2% to 9% [3, 4, 16–21] (Table 2.2). It is especially helpful in this discussion to present data reported by authors who compared two parallel groups of patients – one being treated and one not being treated [18–21]. These are summarized in Table 2.3. This led Michaelson et al. [16] to say that “no notable drop in fellow eye detachment had occurred”, and they officially discontinued the practice of “prophylactic” treatment. Dralands et al. [18]
2 Prophylaxis in Fellow Eye of Primary Retinal Detachment 29 also concluded that “the incidence of second eye detachments does not decrease as the result of preventive treatment”. These data are summarized in Table 2.2. The special category of aphakic or pseudophakic fellow eyes has very little pertinent data from comparative studies in the literature comparing treated and untreated groups. However, such a study was reported in 1989 by Herzeel et al. [22] in which one of the groups was treated with encircling circumferential cryotherapy. They found that the treated group developed retinal detachment in 2.3%; whereas, this outcome occurred in only 1.3% of the untreated group, leading the authors to say that “these results lead us to conclude that ‘prophylactic’ treatment does not necessarily prevent this complication”. A further category of fellow eyes that simultaneously harbor multiple risks has always represented a special group which has been thought to have a more marked vulnerability to detachment and therefore to be pre-eminently eligible for “prophylactic” treatment. However, Folk et al. [21] in 1989 reported comparison groups of fellow eyes, all of which had three simultaneous risk factors for retinal detachment (fellow eye status, lattice degeneration and high myopia). They found that “prophylactic” treatment of the lattice lesions did not confer any advantage in lowering the rate of detachments. Instead, apparently what happens is that, although the risk of detachment is higher with existing multiple risk factors, so also is the risk of secondary detachment following treatment. In fact the incidence of retinal detachment following “prophylactic” treatment is in approximately the same range as the rate of detachment in fellow eyes left untreated. Therefore, we may conclude that the earlier hope of preventing retinal detachment in fellow eyes by some form of “prophylactic” treatment has not been significantly substantiated, and this approach offers no more than a slight benefit. The significant visible predisposing lesions of the peripheral retina, related to retinal detachment, which are primarily lattice
Page 2 and 3: Ingrid Kreissig (Ed.) Primary Retin
Page 4 and 5: Professor Dr. med. Ingrid Kreissig
Page 6 and 7: Contents 1 The History of Retinal D
Page 8 and 9: List of Contributors Gary W. Abrams
Page 10 and 11: List of Contributors XI Hermann D.
Page 12 and 13: 2 Helmholz in 1850 made an accurate
Page 14 and 15: 4 (vitreous, gelatin) into the ante
Page 16 and 17: 6 with scleral resection that set t
Page 18 and 19: 8 ditis [72-74].Temperatures up to
Page 20 and 21: 10 1 The History of Retinal Detachm
Page 26 and 27: 16 ion [147]. Perfluorocarbon liqui
Page 36 and 37: 26 2 Prophylaxis in Fellow Eye of P
Page 42 and 43: 32 found that eyes with pre-existin
Page 46 and 47: 36 3 Encircling Operation with Drai
Page 64 and 65: Chapter 4 Pneumatic Retinopexy for
Page 66 and 67: Technique 57 Case Selection Proper
Page 68 and 69: Technique 59 Table 4.1. Gas charact
Page 70 and 71: Technique 61 solution; however,thes
Page 72 and 73: Technique 63 gas reflux. Following
Page 74 and 75: Complications: Prevention and Manag
Page 76 and 77: New Possibilities 67 ing on type an
Page 78 and 79: Results 69 Table 4.7 (continued) Au
Page 80 and 81: Discussion 71 surgical failures. Fa
Page 82 and 83: Discussion 73 Disadvantages of PR A
Page 84 and 85: References 75 situations, then to p
Page 86 and 87: 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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140 Probably, the future question n
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146 7 Pharmacological Approaches to
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152 heparin was published in eyes u
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154 search for compounds with hepar
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Chapter 8 Systematic Review of Effi
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Materials and Methods 163 Table 8.2
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Discussion 165 30% 25% 20% 15% 10%
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Discussion 167 Fig. 8.2. The small
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Conclusion 169 vitrectomy and searc
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References 171 8. Brazitikos PD, D
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References 173 34. Gunduz K, Gunalp
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References 175 63. Schepens CL (195
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178 9 Repair of Primary Retinal Det
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180 a b Fig. 9.3a,b. Legend see pag
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186 a b 9 Repair of Primary Retinal
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188 might eliminate traction on the
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Chapter 10 Retinal Detachment Repai
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Retinal Detachment Repair: Outlook
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References 207 It is impossible to
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210 C Campbell 7 case selection 57,
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212 M Machemer 13 macular - complic
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214 retinal - detachment - - bilate
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Primary Retinal Detachment

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