Are Encircling and Drainage Still Worth Doing

As every detachment surgeon knows,there are detachments of good and of poor prognosis. Good prognostic signs include: fewer breaks, less extensive area of detachment, shallow detachments and

Fig. 3.7. A detachment with a good prognosis. A one-quadrant detachment, one break, in a 50-year-old male patient, flattened with bed rest. A radial 5-mm sponge was placed, followed by laser

phakic status (Fig. 3.7). Indicators of poor prognosis include: many breaks, undetectable breaks, a large area of detachment, bullous detachment, aphakic/pseudophakic status and proliferations of vitreous and retina (Fig. 3.8). Not surprisingly, these indicators are similar in the literature on both buckling and pneumatic retinopexy [16].

Minimal procedures are appropriate to repair more favorable cases,whereas procedures associated with higher morbidity are reserved for the complex case. Schepens corroborated this finding. "The circling element was at first used in cases with an unfavorable prognosis. As experience with this procedure increased it was used on more and more favorable cases and it was found to be the most dependable operation" [2]. This misconception, that if it is good for complicated cases it is even better for uncomplicated ones, has proved to be a common reasoning in clinical practice, as observed by Lincoff and Kreissig [41].

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

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.

Was this article helpful?

0 0

Post a comment