Advantages of the Balloon Operation

Advantages of the balloon operation are as follows 1. The surgery is short, ranging between 10 min and 20 min 2. The anesthesia is topical or subconjunctival 3. The recovery of vision is fast and optimal 4. The last complications of segmental buckling are eliminated, i.e., there is no buckle infection,because the balloon is removed, and no diplopia. Diplopia, if present, disappears after the balloon is withdrawn. Fig. 6.12. Old inferior detachment. a The detachment has several pigment...

Improvement in Visual Acuity

Improvements in visual acuity following reattachment surgery may be achievable using several different methods. The first would be a reduction in the rate of complications associated with macular dysfunction. These include both macular edema and macular pucker. Both are well-described complications of retinal reattachment surgery as well as other vitreoretinal conditions and may be amenable to pharmacological intervention. Recent reports suggest that intra-vitreal steroids, principally...

Origins of Minimal Segmental Buckling Without Drainage

Minimal segmental buckling without drainage for repair of a primary rhegmatogenous retinal detachment is an extraocular technique in which the buckle and the coagulations are limited to the area of the break. The two components of this procedure can be traced back over several decades. The present minimal surgery developed in small steps over the years. Eliminating drainage of subretinal fluid and applying the surgery only in the area of the break was a change from treating the entire extent of...

Drugs Acting on the ECM

Drugs which act on the interface between cells and the ECM have the potential to inhibit intraretinal scarring at a relatively earlier step than simple proliferation. Heparin and related peptides have a multitude of effects on cells and their interaction with the ECM. Heparin is a glycosaminoglycan derived from heparin sulfate, which binds to several ECM proteins, including fibronectin, laminin, and vitronectin 48 . In addition to its antithrombotic properties, for which it was first discovered...

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,...

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 History of Retinal Detachment Surgery

Gonin Retina

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

Vortex Vein

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...