Some Basics of Surgical Technique

This surgery, performed under local anesthesia, is suitable for primary retinal detachments caused by one or several breaks. It consists of cryosurgery under ophthalmoscopic control and a sponge, preferably radially oriented, to the break. Consequently, the size of the buckle is determined only by the size of the break(s) and not by the extent of the detachment. The treatment of the two detachments, presented in Fig. 6.1, is the same and consists of a sponge buckle of equal size. After an...

References

Ware J (1805) Surgical observations relative to the eye, 2nd edn. London, pp 1-510 2. Wardrop J (1818) Essays on the morbid anatomy of the human eye. Edinburgh, pp 2-64 3. Panizza B (1826) Sul fungo midollare dell'occhio. Pavia 4. Rucker CW (1971) A history of the ophthalmoscope. Whiting Printers, Rochester, MN, p 23 5. Coccius A (1853) Ueber die Anwendung des Augenspiegels nebst Angabe eines neuen Instruments. Immanuel Mueller, Leipzig, p 131 6. von Graefe A (1854) Notiz ueber die im...

Retinal Detachment Repair Outlook for the Future

Due to the pioneering work of many ophthalmologists, including Gonin, Lincoff, and others, the basic pathophysiology of rhegma-togenous 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...

Scleral Buckling

Mueller introduced shortening of the sclera in 1903 for reducing the volume of the globe 79 . Lindner, in 1931, revived this technique by performing a perforating sclerectomy and removing a meridional section of sclera 9 . Due to its difficulty and high complication rate it was replaced by lamellar scleral resection that was originally introduced by Blascovics in 1912 and later popularized by Shapland (1951-1953), Dellaporta (1951-1957), and Paufique (1952) 47,48,61,80,81 .Using this technique,...

Conclusion Of Retinal Detachment

In the beginning of the twenty-first century, the present state-of-the-art for repair of a primary retinal detachment has reverted from a local to a barrier concept of treatment - as has happened several times during the past 75 years. External buckling local buckles with coagulations limited to the break (Fig. 9.5a, b) are becoming replaced by local buckles supplemented by an encircling band with extended coagulations (Fig. 9.4a, b), applied as a barrier against redetachments. The same applies...

Surgical Technique

Advances in surgical instrumentation and technique have made vitrectomy a safer and more effective procedure in an eye with a detached, mobile, elevated retina. Critical components of the surgical instrumentation should include a high-speed vitreous cutter (2,500 cuts min), a panoramic viewing system, and perfluoro-carbon liquids. High-speed vitreous cutters allow shaving of the vitreous near mobile retina. The vitreous traction can be relieved around the tear, and it is possible to shave...

Prophylaxis in Fellow Eye of Primary Retinal Detachment What Not to Do and What to Do

It is generally very helpful in understanding the present to make a retrospective survey of the thinking of the past, which has led us to our present concepts. The progression of ideas in the case of prophylactic treatment of retinal detachment first developed from a few correct elementary clinical observations, but then proceeded on the basis of mostly theoretical reasoning because of the profound dearth of empirical data. Along with the early realization that some retinal detachments could be...

Vitreous Surgery

Von Graefe and Deutschmann were the first clinicians to advocate cutting vitreous and or retina in order to treat retinal detachment however, they did not cut vitreous gel, but mainly cut vitreous membranes with a knife 17,110 . Von Hippel in 1915 cut a vitreous membrane and successfully treated a tractional retinal detachment 111 . The first modern intraocular instruments, made specifically for cutting vitreal membranes, were developed in the second half of the twentieth century. Neubauer in...

Indications

The indications for the choice of vitrectomy as the primary method for managing retinal detachment is quite varied among surgeons. Some believe that it should be used in every case, and others feel that a scleral buckle should be attempted first in all cases before vitrectomy is done. Until the clinical evidence can be established for each end of the spectrum, I have chosen an approach that is somewhat more conservative and that balances the risks of vitrectomy with its benefits. Table 5.1....

The Present State of the Art and How It Came About

A major advance in the concept of treating a primary rhegmatoge-nous retinal detachment was the realization that the surgical problem was solely closing the leaking retinal break and that the extent of the detachment or tractional configurations remote from the break are of no consequence. Let us share with you this change in concept over time 1 . Recall, Gonin 2 postulated - for the first time - that a leaking break is the cause of a retinal detachment, and his treatment was limited to the...

The History of Retinal Detachment Surgery

The history of retinal detachment surgery is one of the great success stories in the history of medicine. The first descriptions of retinal detachment were by Ware in 1805, Wardrop in 1818, and Panizza in 1826 1-3 . These descriptions relied mainly on pathological observations. The introduction of the ophthalmoscope by Fig. 1.1. Jules Gonin. (Reproduced with permission Wilkinson CP, Rice TA (1997) Michels retinal detachment, 2nd edn. Mosby St. Louis MO. pp 241-333 10 ) Fig. 1.1. Jules Gonin....

The Cell Biology of PVR

PVR is the most common cause of failure following attempted retinal reattachment repair in primary cases, as well as complex forms of retinal detachment. The precise initiating events remain poorly understood, but it is known that the disease is characterized by cell-mediated tractional forces exerted on both preretinal and subretinal membranes, as well as more diffusely to the vitreous gel itself 9,14,15 . These contractile forces lead to stiffening and elevation of the retina, leakage through...

Complications of Encircling

Complications of encircling include surgery in all quadrants in all cases, increased myopia, strabismus, internal erosion, the string and Fig. 3.3. Pathological specimen of an enucleated eye with a large buckle which had caused motility problems Fig. 3.3. Pathological specimen of an enucleated eye with a large buckle which had caused motility problems purse-string syndromes as well as short- and long-term effects of choroidal ischemia and reduced pulse amplitude 17,18 . Some of these events can...

Intraocular Tamponade

Another technique to help appose retina and choroid that could be used in conjunction with other procedures was injection of air into the vitreous cavity. Originally described by Ohm in 1911 and then by Rohmer in 1912, injection of air at the end of the operation was adopted by Arruga in 1935, and to close retinal breaks by Rosengren in 1938 32, 34,139 . Rosengren carefully localized retinal breaks, then placed penetrating diathermy in a pattern covering an area 6-7 mm in diameter with drainage...

Retinopexy

Many techniques were proposed for the creation of chorioretinal adhesions. Diathermy became the worldwide standard for retinopexy until the adoption of cryopexy in the 1960s. However, other methods were transiently used. In 1931, Guist cauterized the choroid around the break by touching it with a caustic potash stick in several places after it had been exposed with trephine openings through the sclera and the subretinal fluid drained 51 . This method was further modified by Lindner 52 . Passage...