R 463
Treatment of retinal detachment: By extraocular or intraocular surgery?
I. Kreissig
Purpose: To analyze the preconditions which resulted in the present state of art of extraocular (e.o.) and intraocular (i.o.) surgery for retinal detachment. To examine whether there is a difference in the reattachment rate and morbidity between e.o. and i.o. surgery for retinal detachment.
Patients and Methods: Extraocular minimal surgery: 500 retinal detachments were treated with a temporary balloon buckle without drainage. They had 1 hole or group of holes within 1 clock hour. 30 eyes were previously operated upon with another procedure, 3 had a perforating injury, 70 had moderate vitreous hemorrhage, and 5 eyes had PVR C1/C2. An additional 107 detachments were treated with segmental buckle(s) limited to the area of the break without drainage of which 16 eyes had PVR C1/C2. Morbidity and reattachment rate were compared with the results after intraocular surgery: 500 uncomplicated detachments and 672 detachments with uncomplicated and more complex breaks were treated with pneumatic retinopexy and 595 primary detachments were treated with vitrectomy with gas.
Results: Retinal reattachment after e.o. and i.o. surgery was comparable ranging between > 90% and 99%, however: 1. Reoperation after i.o. surgery was at 19%, 26% and 24.5% respectively, but after e.o. surgery at 7.6% and 8.4%. 2. PVR after i.o. surgery was at 4%, 6% and 11.5% respectively, but after e.o. surgery at 0.2% and 3.7%. 3. The rate of PVR and of reoperation after vitrectomy were not different than after gas alone.
Conclusions: The present state of art of retinal detachment surgery has improved the prognosis of reattachment from 90% to almost 100%. The aim of future should be: 1. To reduce the morbidity and rate of reoperation with i.o. surgery, 2. to develop procedures with less morbidity and 3. to search for techniques which will provide in a pseudophakic eye with a detachment years after cataract operation clear optic media and a pupil to be dilated, thus to enable precise preoperative diagnostics and a primary e.o. minimal ap-proach, time-tested and with favourable long-term visual results, instead of a detachment surgery combined with a preceding anterior segment operation.
Universität Tübingen, Augenheilkunde III, Schleichstr. 12, D-72076 Tübingen