Minimalizing surgery of retinal detachment

Abstract

The prerequisites for minimizing detachment surgery are (1) dispensing with drainage by using elastic plug materials limited to the area of the tear and (2) improved diagnostic methods for detecting retinal tears. Various procedures are being developed on this basis in which the extent of surgery is dictated by the size of the tear alone, and no longer by the extent of the detachment. These procedures include (1) the cryosurgical detachment operation for treating several tears with individual, permanent plugs and (2) the balloon operation for single-tear detachments, with a temporary plug; both are extraocular procedures. However, for retinal tears which are difficult to plug (giant tear, tear at the posterior pole), intraocular procedures are indicated, namely (3) surgery with expanding gases and (4) the balloon gas method, with intravitreal or retrohyaloid injection of the gas. If the gas injection is combined with a parabulbar balloon, the number of such injections can be reduced to one; the gas tamponade is nevertheless sufficiently large. With the modified balloon gas procedure with retrohyaloid gas injections the number of vitreous complications can be reduced. The procedures described can be used in more than nine out of ten cases of rhegmatogenous detachment. Postoperative results with this minimum detachment surgery are good: in more than nine out of ten cases the retina is reattached. The operation is a minor one, can always be performed under local anesthesia, and is of short duration, with a minimum of trauma and complications.