Primary Retinal Detachment

More documents

Recommendations

Info

48 3 Encircling Operation with Drainage for Primary Retinal Detachment Fig. 3.8. A detachment with a poor prognosis in a 42-year old male patient. There were eight breaks. It was a reoperation with PVR stage B, unresponsive to bed rest. Five segmental buckles were placed. The retina attached without drainage. After 3 months the retina redetached due to PVR. This may represent the limit of the segmental buckling technique Encircling and drainage may still be of value in highly bullous detachments not responding to bed rest, many breaks of similar latitude, anterior vitreoretinopathy, need for a higher and more permanent buckle and thin sclera interfering with suturing. The author prefers encircling for most revisions of failed segmental buckles. The reasons are psychological and practical: the minimal procedure has failed and the revision includes the preparation for possible vitreous surgery. The band is in place, but may not be tied. Conclusion Whereas modern examination techniques facilitate localization of breaks and allow for precise treatment of the holes, drainage and
Conclusion 49 encircling continue to be popular and are used by a majority of surgeons. Careful preoperative examination including a detailed fundus drawing was advocated by Schepens and should still be done,irrespective of the surgical method.Examination is time consuming in the age of managed care and even the best effort cannot always identify all breaks. For the buckling procedure to be successful, all breaks have to be identified and closed, encircled or not. Encircling and drainage were successful in 78–96% and have become synonymous with scleral buckling [15, 37]. Since the 1950s, at least two generations of surgeons have been well trained in this procedure. It is “dependable” and incorporates the barrier concept [2]. Intraoperative localization as to latitude is critical, but meridional localization may be less precise compared with minimal radial buckling. The vitreous base is ring-like; supporting it treats the hidden break and the anticipated traction. Broad buckles support anterior PVR and circumferential retinotomies [42]. This “ring” concept is behind prophylactic buckling and laser circling for 360 degrees, as they are meant to barrage and reduce the incidence of secondary breaks in alternate techniques [14, 16]. Most encircling is reversible: a band can be cut in a timely fashion without re-detachment or permanent damage from ischemia. Can the surgeon sleep better after the retina has been drained flat? It depends: a non-drainage procedure increases the chance of primary failure, but the eye will survive the attempt almost intact. By draining, the retina may be attached on the table, yet morbidity (blood under the macula etc.) may forever preclude visual recovery. Who could sleep well after the latter? From a pathologist’s viewpoint, drainage will always be a penetrating injury to a vascular tissue in an inflammatory and hypotonous setting. The data reporting intraocular hemorrhage attest to this simple fact that cannot be changed by even the most sophisticated technique. The fear of anatomic failure (first operation success or lack thereof ) apparent to both physician and patient has helped the propagation of techniques that flatten the retina under the surgeon’s eye, like external drainage or internal drainage during
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
Page 88 and 89: References 79 51. Pournaras CJ, Don
Page 90 and 91: Chapter 5 Vitrectomy for the Primar
Page 92 and 93: Indications 83 Table 5.1. Indicatio
Page 94 and 95: Indications 85 Fig. 5.2. The vitreo
Page 96 and 97: Surgical Technique 87 vitrectomy an
Page 98 and 99: Outcomes 89 will be visible under a
Page 100 and 101: Outcomes 91 almost no persistent su
Page 102 and 103: References 93 7. Heimann H, Bornfel
Page 104 and 105: 96 6 Minimal Segmental Buckling Wit
Page 106 and 107: 98 6 Minimal Segmental Buckling Wit
Page 108 and 109:
100 the operating table with the re
Page 110 and 111:
102 6 Minimal Segmental Buckling Wi
Page 112 and 113:
Page 114 and 115:
106 a b 6 Minimal Segmental Bucklin
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
114 a 6 Minimal Segmental Buckling
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
122 c d 6 Minimal Segmental Bucklin
Page 132 and 133:
124 c Fig. 6.14c 6 Minimal Segmenta
Page 134 and 135:
Table 6.1. Preoperative characteris
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 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
140 Probably, the future question n
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
146 7 Pharmacological Approaches to
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
152 heparin was published in eyes u
Page 162 and 163:
154 search for compounds with hepar
Page 164 and 165:
Page 166 and 167:
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 188 and 189:
Page 190 and 191:
Page 192 and 193:
186 a b 9 Repair of Primary Retinal
Page 194 and 195:
188 might eliminate traction on the
Page 196 and 197:
Page 198 and 199:
Chapter 10 Retinal Detachment Repai
Page 200 and 201:
Retinal Detachment Repair: Outlook
Page 202 and 203:
Page 204 and 205:
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
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
show all

Primary Retinal Detachment

Create successful ePaper yourself

Delete template?

Save as template?