|Year : 1983 | Volume
| Issue : 5 | Page : 540-542
Management & analysis of retinal detachment
Little Flower Hospital, Angamally, India
T P Ittyerah
Retinal & Oculoplastic Surgeon, Little Flower Hospital, Angamally, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ittyerah T P. Management & analysis of retinal detachment. Indian J Ophthalmol 1983;31:540-2
With a remarkable improvement in the results of detachment surgery many young ophthalmologists are taking up this branch. Through this paper I would like to share my experience in analysing 50 cases of retinal detachment operated during 1979.
| Materials and Method|| |
50 Cases were selected from 65 cases of detachment attended during this period. Detailed examination with vision, refraction, tension were done. All the cases were examined with Indirect Ophthalmoscope with scleral indention. Where ever necessary, 3 Mirror examination also was done. The findings were drawn. In 5 patients detachment was bilateral and in 7 patients the other eye retina was not visible. The operation was done either under G.A. or L.A. according to the age and cooperation of the patient. (LA in 47 cases and GA in 3 cases).
Pre-operatively bed rest was recommended in cases where there was threatening of macular detachment. Procedure employed was encircling and segmental buckling. In this study only Silicon MIRA 240 Band was used for encircling and as implant various types of MIRA Silicon Rubber Implants of 200 series were used to produce segmental buckle. In one case one vortex vein was sacrificed. In all cases circumferential buckle was used except one. For the matress sutures for the buckling and for anchor sutures of band, 5 zero supramid was used. To produce the aseptic inflamation cryo was used (Amoils Cryo with Co 2).
Technique used was: Encircling alone-6! S. Buckling alone-3; S. Buckling with Encircling-41;.
The fluid was drained with one perforation in 42 and two in 8 cases.
In four cases vitreous injection was carried out-air in 3 and in saline in one.
The lamellar bed was disected with razor blade piece held in the blade holder. The sharp edge was used to cut the sclera and blunt surface to disect. This instrument I find, is ecnomical and dependable. One has to avoid all temptation to disect and separate the sclera with the sharp edge especially if used without magnification.
| Observations|| |
Eye operated-Right eye-21(42%); Left eye-29 (58%).
These were 30 (60%) in males and 20 (40%) in females.[Table - 1]
Refractive state associated:
Myopia-14 (28%; Aphakia-(34%); Hypermetropia-2 (4%); Emetropia-17 (34%).
Type of Retinal Break:
Dialysis-3 (6%); One Hole-24 (48%); More than 1 hole-16 (32%); No hole (unholy) -7 (14%).
Shape of holes:
Horseshoe-20 (40%); Round-10 (20%); Irregular-3 (6%); More than one type of holes-9 (18%).
Area of detachment:
Total detachment-24 (48%); Macula alone -2 (4%); Macular & periphery but not total18 (36°x,): Macula not involved-6 (12%).[Table - 2]
Vision improved-31 (62%); Unchanged-11 (22%x); Deteriorated-8 (16%).
| Discussion|| |
The final objective of retinal detachment surgery is to keep the retina attached permanently and to obtain the maximum vision possible both acuity and field with least amount of complications. To obtain this detection of hole or holes breaks are very important. Even after sincere efforts to detect hole using various methods of examination about 14% of cases remained without detection of hole. We used the Cryo Coagulation in all the cases. The razor blade is found to be a useful, dispossible the economical aid to disect the scleral bed, to make sclerotomy opening and in some cases to drain the fluid by making the nick on diathermised choroid. For various reasons I preferred, intrascleral implant surgery. Photocoagulation (Xenon) was used to coagulate the macular holes, the missed holes and to strengthen the reaction on the buckle around the hole'. I have not included any detachment with giant tear in this study because the management and prognosis are fundamentally different. The disadvantages I have noted with implant surgery are (1) Technical difficulties to disect under the Muscle (I) Time consuming (3) Perforation while applying cryo in the bed. The drainage of sub-retinal fluid before Cryo coagulation helps the surgeon by giving better space due to the reduced volume of eye ball. It also avoids the change of prolonged increase in ocular tension while doing cryo coagulation. If the eye becomes soft indirect ophthalmoscopy in the classical way becomes difficult. I used to visualise the hole and cryo reaction without the condensing lens in such cases. This is easier especially if the holes are anterior to equator and there is no invertion of image. The only disadvantage is that occasionaly pupil constricts due to hypotony. The encircling element has kept the buckle permanent in our cases and also gives a ridge all around.
In most of the cases the surgery was performed under local anastheasia. In all the cases a silicon rubber implant was used corresponding to the hole or tear. Cryocoagulation of the scleral bed (disseeted with razor blade) was done before fixing the implant. The whole surgical procedure including drainage of S.R.F. was done under 4 x magnification (operating spectacle and each cryocoagulation was monitered by indirect ophthalmoscopy.) The results and complications of this surgery discussed. There was 80% of success (anotomical approximation). The patients were followed up for a period of one and a half years.
| References|| |
Schepens, C.L., Okamura, I.D., and Brock hurst R.J., Arch. Ophthalmol., 64, 868, 1957.
Schepens C.L., Symposium, Trans. Amer Acad, Ophthalmol., Otolaryng, 62,
Schepens, C.L., Okamura, I.D., Brockhurst R.J,, and Regan C.D.J., Arch. Ophthalmol., 64, 868,
[Table - 1], [Table - 2]