|Year : 1982 | Volume
| Issue : 6 | Page : 569-571
Hemicirclage - A modified technique in retinal detachment surgery
DN Gangwar, IS Jain, Amod Gupta, SL Bansal, P Pillai, V Mathew
Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
D N Gangwar
Deptt. of Ophthalmology, P.G.I. Chandigarh 160012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gangwar D N, Jain I S, Gupta A, Bansal S L, Pillai P, Mathew V. Hemicirclage - A modified technique in retinal detachment surgery. Indian J Ophthalmol 1982;30:569-71
An attempt therefore, has been made to develop "hemicirclage" a part circling procedure of the globe retaining the basic advantages of encircling as far as possible and yet curtailing its disadvantages. This is possible by decreasing the extent of encircling and tailoring it to exact needs of the patients, that is
varying from 1/3rd to 3/4th of the circumference of the globe. The technique and our initial experience on 10 cases operated by this technique is described.
| Materials and methods|| |
More than 10 patients of retinal detachment have undergone the procedure of hemicirclage with a follow-up varying from 2 to 6 months but the results of 4 pateints one described. The procedure is as follows :
A sillicon rubber rod (2mm) or strip (5mm) was used in all cases. Conjunctival incision is made 5mm posterior to the limbus in the segment where the hemicirclage is to be applied. As usual, the retinal breaks are localised and sealed using mild trans-scleral diathermy or cryopexy. One end `A' of the rod is security anchored to the sclera at the desired position by means of two radially applied terrylene sutures 1.5 mm apart and engaging a d:ep bite of sclera. The other end `B' of the rod is pulled circumferentially to give a desired indentation effect on sclera and then stitched like `A'. If need be an additional central suture is applied to keep the hemicircling in position. 2-3 mm of the rod on either side is left as free end to prevent for any loosening of the sutures at a later data and thereby prevent slipping of the rod. When a strip is used, it is similarly anchored but the end sutures are actually passed through the strip to hold its central 2/3rd. The total length and position of the hemicirclage is so adjusted so as to cover all the retinal breaks and also other potential pathological areas and can vary from I to 3 segments of globe. If need be, subretinal fluid is drained before tying the final suture on the half circling band. Finally the conjunctiva is sutured with a 6-0 black silk suture after applying interrupted sutures to the Tenon capsule.
| Observations|| |
Results are shown in [Table - 1]. 4 cases are described in some details who have had more than 3 months of follow up.
| Discussion|| |
The development of this simple part circling procedure was prompted by an observation during routine retinal detachment surgery that the encircling band did not slip well through even a slightest tightening of the radially placed anchoring suture and also that this way a differential buckling effect could be produced in the desired area.
The hemicirclage procedure is similar to the encircling in a way that it also produces buckling effect by virtue of its elasticity.
It differs from the local circular buckle, where in the buckling material is pushed mechanically into the sclera by means of multiple scleral sutures. The advantages of the hemicirclage procedure over a local circular plomb are :
(a) It is an easy and short procedure
(b) Potential complications of applying multiple scleral sutures are avoided.
(c) The desired extent of bucking can be varied from less than I segment to over 3 segment.
The procedure has obvious advantages over the conventional encirclage, yet retaining all its virtues.
(i) Besides being a time saving procedure hemicirclage is limited to only that half of the eyeball where buckling is desired; thus sparing the other half from surgical trauma. This results in a smooth post operative period.
(ii) Persistent neuralgias and eyebrow aches so frequently seen following encircling procedures are significantly unencountered. Only I case had a mild short lived eye-brow ache.
(iii) Anterior segment ischaemia and aseptic uveitis have not been seen in any of the patients. This is because of sparing of the long ciliary vessels and nerves and also because hemicirclage cannot be tied too tightly.
(iv) Disease free, undetached part of the retina is not unceremoniously molested as in encircling and functional integrity of the unoperated retina is maintained.
(v) As in encircling, the vitreo-retinal traction is relaxed in the buckled half and may facilitate some vitreous push to the opposite side thereby relaxing vitreo-retinal traction all around.
No appreciable change in corneal curvature was noted as shown by pre and post operative keratometry. Only case 2 had noticeable change which returned to normal in due course.
The buckle effect of the hemicirclage varied from 6 to 12 dioptres initially as measured by the direct ophthalmoscopy from crest of buckle to its just posterior settled retina. In case No. 2 it gradually shallowed in about 2 months time, the reduction occurred at a rapid pace during the latter half.
The hemicirclage is more useful in the following situations wherein a conventional encircling procedure would otherwise be indicated.
(1) Segmental retinal detachments with multiple breaks in the detached area.
(2) Aphakic retinal detachment with single or multiple breaks.
(3) Segmental retinal detachments without any evident breaks.
(4) Local R.D. with a single hole and adjacent area showing a lot of vitreo-retinal pathology.
(5) Selected cases of ant. dialysis.
It would be in place to discuss some of the potential disadvantages of this procedures.
Is it going to stay long enough to serve its purpose.
Conventional encircling effect remains as long as it does not slip, get infected, erode into the eye or is removed. In none of the cases followed so far has this complication been seen. Though a longer follow up would be required to definitely comment about this complication.
| Summary|| |
"Hemicirclage" a new surgical approach for `part circling of the globe' along with our initial experience in 10 patients has been described. The operation in general retains the basic advantages of conventional encircling procedure but considerably minimises its drawbacks. This operation is not a replacement of conventional encircling which can still be done with advantage in many cases but a large number of patients where initially encircling was considered necessary can be advantageously shifted to this procedure. Hemicirclage is in fact a step between massive encircling and minor local plomb procedures and fills a void often looked for.
| References|| |
Bietti, G.B., 1965, Trans. Ophthal. Soc. U.K. 85: 93
Boni U.K,, M, and Zimmerman, L.E., 1961 Trans. Amer. Acad. Ophthalmol. 65: 671
Hudson, J.R., 1964, Proc. Roy. Soc. Med. 57:778
Manson, N., 1964, Brit. J. Ophthalmol. 48: 70
Meyer, Schiwichkerath, G. 1966. Mod. Prob.Ophthalmol. 4, 263
Mortoda, A., 1978. Ophthalmologica, 177: 22.
[Table - 1]