THE ROLE OF VITREOUS IN RETINAL DETACHMENT SURGERY WITH EXTERNAL BUCKLING
U. Mester1, N. Anterist1, P. Kroll2, S. Brieden2
Purpose: To prove the role of vitreous in retinal detachment surgery with scleral buckling procedures we retrospectively investigated the chards of patients who were operated on for retinal detachment by scleral buckling between January 1995 and June 1997.
Patients: Out of a total of 718 cases, 41 retinal detachments occured in previously vitrectomized eyes. 48 of the remaining 677 eyes were highly myopic (= 10 D) with advanced collaps of the vitreous. The buckling procedure consisted of silicone sponge explants in 513 cases (254 radial, 259 circumferential) and of encircling elements in 202 cases. 3 eyes received a temporary ballon. The minimal follow up was 3 months.
Results: After primary surgery in the 677 non vitrectomized eyes, the retina was attached in 482 eyes (71.2 %), after reoperation in 627 eyes (92.6 %). With up to three reoperations (including vitrectomy with gas or silicone oil tamponade in 79 eyes) the final success rate was 98.7 %. The correspondent reattachment rates in the 41 vitrectomized eyes were 82.9 % after primary surgery and 97.6 % after reoperation. Repeated surgery in 6 eyes consisted of successful internal tamponade by silicone oil due to proliferative vitreoretinopathy. One patient refused any further treatment. 48 highly myopic eyes (= 10 D) gained reattachment after primary surgery in 58.3 %, after reoperation in 93.7 %, and after three operations in 95.8 % (including vitrectomy with gas or silicone oil tamponade in 8 eyes). The reattachment rates after primary surgery are of most interest to the role of vitreous in buckling procedures because reoperations included internal tamponades also. The highest success rate was gained in the vitrectomized eyes (82.9 %) versus 71.2 % in the non vitrectomized eyes and 58.3 % in the group of highly myopic eyes.
Conclusions: We therefore conclude that, the absence of vitreous has no adverse effect on the results of buckling procedures for retinal detachment. The choice of the surgical technique in treating retinal detachments in vitrectomized eyes should only be determined by the retinal findings as number and extent of breaks or presence and stage of proliferative vitreoretinopathy.
1Department of Ophthalmology, Bundesknappschafts Hospital Sulzbach
2Department of Ophthalmology, University of Marburg