Year : 1953 | Volume
: 1 | Issue : 2 | Page : 45--56
Detachment of retina
Department of Ophthalmic, Lake Medical College Hospital, Calcutta, India
Department of Ophthalmic, Lake Medical College Hospital, Calcutta
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Sen K. Detachment of retina.Indian J Ophthalmol 1953;1:45-56
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Sen K. Detachment of retina. Indian J Ophthalmol [serial online] 1953 [cited 2022 Jan 28 ];1:45-56
Available from: https://www.ijo.in/text.asp?1953/1/2/45/40798
During the period from December 1947 to May 1951, 93 patients of detachment of retina were admitted into the Ophthalmic wards of the Lake Medical College Hospital, including four that were operated previously, three in this hospital and one elsewhere, but got a recurrence of the detachment during the above period.
Age group shows a maximum incidence of 26 cases between 41-50 years, then 21 cases over 50 years, 15 cases each for the three decades between 11 and 40, and one only under ten years.
Nationality : It shows an incidence almost proportionate to the population of Hindus, Muslims, Europeans and Anglo-Indians at 84. 5, 2 and 2 respectively.
Sex : The preponderance of incidence in the male sex, 82 over the female 11 is noteworthy.
Side affected : Both right and left eves show an almost equal affection at 44 and 42 respectively with seven cases in which both the eyes were affected.
Refractive condition of the eye : 18 cases were emmetropic, 12 had myopia of less than 4D, 39 had myopia of over 4D, 10 cases were hypermetropic, 13 had aphakia and in 1 the refractive condition could not be determined because of a funnel-shaped bilateral detachment with indefinite history.
Trauma : We could elicit a history of direct trauma in 1 case and indirect trauma in 7 cases only. It is interesting to note that only one of these eight had myopia of over 4D, the rest were 6 emmetropic and I aphakic subjects.
Detachment and Aphakia : Thirteen cases i.e. 140 of detachments were found in aphakic eyes. In three of these the detachments were almost complete with poor projection, one of which had to be operated in the presence of a complete baloon detachment with low tension, as that was his only eye, but operation failed to give him any relief.
One case was inflammatory in nature and improved with treatment. Two others refused operation.
In all nine cases were operated, including the one mentioned above, out of which in five the results were successful. In two cases the detachments recurred after five to six months. A reoperation was done without success in one case, and successfully in the other.
Recurrences : In nine cases the detachments recurred. In all of them this was due to formation of either a hole or a tear in a different area. In four cases a second operation was done but proved a failure. One of theta lost his eve from in endophthalmitis. He was a diabetic with a fasting blood sugar level of 200 mg. per c.c. but no sugar in the urine. Two other cases. one operated elsewhere previously and one at the Lake Hospital in 1946, in whom the detachments recurred after more than 2 years, were operated upon with successful results. (Cases 28 & 34)
Holes and tears : Out of the 58 cases operated, holes were found in 55. One of the three (case 13) in whom no hole was found, was operated upon but when the subretinal fluid was withdrawn it was yellow in colour giving rise to suspicion of an inflammatory nature of the detachment. The balooning got worse eight days after the operation. Exudates and haemorrhages developed later and the condition eventually settled down in six months, confirming the suspicion that had arisen daring the operation.
In the second case (case 38) with no holes, the area surrounding an old patch of anterior choroiditis was coagulated with a successful result, the vision improving to 6/36 from baud movements.
In the third case (case 50) where no holes were found, there was a thinned area of retina by the side of all old patch of choroiditis, which area was coagulated. The operation was successful, the vision improving to 6/36 from finger counting at 1½ meters.
Thirty-nine cases were not operated for the following reasons:
(1) Seven cases left the hospital, a short time after admission on signing the risk bond.
(2) Five cases were due to localised choroiditis, at or near about the macular region.
(3) In live cases the vision improved with rest and conservative treatment
(4) In one case there was optic atrophy and a cry poor projection of light.
(5) In three cases there was extensive retinitis proliferans after Eale's disease.
(6) In eleven cases there was total detachment, from baloon to funnel ill shapes the duration varying front 3 to 12 months. All had very low tension.
(7) Eleven cases were of extensive exudative choroiditis in four of which cyclitis and iritis were present.
(8) One case was of it retinopathy of pregnancy with extensive bilateral detachment in a hypertensive pregnant woman whose vision improved to 6/18 in right eve and 6/24 in the left after a therapeutic abortion.
Fifty-four cases were operated upon including two cases who were operated before December 1947 and got recurrences. In five of these the operation had to be done a second time, making a total of 59 operations.
The technique of the operation was by a diathermy coagulation of the tear-area and a barrage of diathermy points surrounding the tears or beyond the areas of dialysis as the case may be.
When the tear, hole or tear area is on retina which is not raised more than two mm. from the choroid, surface diathery is used. In other cases, penetrating diathermy is required to reach the retina. This is followed by evacuation of sub-retinal fluid at the most dependent part either by penetrating diathermy, or after trephining the sclerotic with 11 min. trephine. Two points of surface diathermy are put on the sclerotic to coagulate the blood vessels in the choroid. The trephine is put on that area and cut obliquely in order to have a hinge to the disc. The choroid is punctured with a canaliculus dilator to let out the subretinal uuid.
The table at the end gives the details about the cases. In 11 cases, operation failed to give relief, including case No. 23 -where there was an anatomical cure but the vision did not improve. In three of these, including the one described under aphakia a severe form of endophthalmitis resulted. The one already described can be explained by his having diabetes, the second one was highly allergic to sulphonamides and penicillin, but no cause could be detected for the third case.
The visual end results three months after the operation are tabulated below [Table 10]
In one case (case 54) the success or otherwise of the operation could not be determined, as he left the hospital soon after the operation after signing the risk bond. His retina was in position on leaving the hospital.
In many cases the result was vitiated by either lens opacities, or vitreous opacities. and patches of choroiditis near the macular region. (See table).