Rhegmatogenous Retinal Detachment Treatment & Management

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Aug 10, 2011
 

Medical Care

No role exists for medical care in the treatment of rhegmatogenous retinal detachments (RRDs).

Next

Surgical Care

Regardless of the surgical technique chosen, the surgical goals are to identify and close all the breaks with minimum iatrogenic damage. Closure of the breaks occurs when the edges of the retinal break are brought into contact with the underlying RPE. This is accomplished either by bringing the eye wall closer to the detached retina (a scleral buckle) or by pushing the detached retina toward the eye wall (intraocular tamponade with a gas bubble). Sealing of the breaks is accomplished by creating a strong chorioretinal adhesion around the breaks; this may be completed with diathermy, cryotherapy, or laser photocoagulation.

During diathermy, an alternating electrical current of 13.56 MHz is generated. As the current passes through the tissue, resistance of the tissue gives rise to heat. This heat coagulates the tissue. Diathermy produces an adequate RPE adhesion, but it produces immediate scleral shrinkage with subsequent scleral necrosis. This leads to complications during reoperations and an increased rate of scleral abscess formation. Diathermy is generally used during implant procedures.

Cryotherapy avoids all the complications of diathermy. However, it breaks down the blood-ocular barrier and may cause dispersion of RPE cells into the vitreous cavity, which may contribute to PVR. Following cryotherapy, the retinal RPE adhesion is usually weaker during the first week, but, by the end of the second week, the adhesion attains its strongest strength.

Laser photocoagulation causes the least morbidity. However, it requires the retina to be flat over the RPE before a chorioretinal adhesion can be formed. The adhesion attains its maximum strength at 7 days.

Scleral buckles usually are made of solid silicone and silicone sponges. Other materials, such as fascia lata, gelatin, and preserved sclera, have been used at different times for scleral buckling.

Scleral explant

Initially, Custodis described this technique, which Lincoff later modified.[8, 9]

A conjunctival peritomy is performed with isolation of the recti muscles.

Indirect ophthalmoscopy is used to localize all the breaks. Once the breaks are localized, they are usually treated with cryotherapy.

A buckling element is chosen and sutured over the breaks.

The surgeon decides whether to drain the subretinal fluid. The buckle is adjusted to an appropriate height. The central retinal artery is monitored carefully during this maneuver.

In cases where the subretinal fluid is not drained, an anterior chamber paracentesis and/or liquid vitreous removal is performed.

Postoperative visual acuity seems to show a worse prognosis if the repair is performed after 6 days of a macula-off RRD.

Scleral implant

Schepens popularized this method.[10]

A conjunctival peritomy is performed with isolation of the recti muscles.

Indirect ophthalmoscopy is used to localize all the breaks. A partial lamellar scleral resection is performed in the area of the breaks.

Diathermy is used to create a chorioretinal adhesion.

A scleral implant is chosen and put in the bed of the dissected sclera.

Drainage of the subretinal fluid is undertaken.

The sclera is sutured over the implant.

Drainage versus no drainage

The drainage of the subretinal fluid is a controversial topic among vitreoretinal specialists. Reasons given for drainage include reduction in intraocular volume, which allows elevation of the buckle without the problems of increased intraocular pressure and settling of the breaks on the buckle allowing rapid closure of the breaks.

Complications during drainage include choroidal hemorrhage, retinal perforation, retinal incarceration, and choroidal neovascularization.

Arguments against drainage involve the avoidance of the complications of the drainage procedure. Studies by Chignell et al and Lincoff et al have shown that nondrainage procedures work as well as drainage procedures.[11, 12] In these patients, intraocular pressure must be monitored carefully. Most of these patients require a paracentesis or removal of liquid vitreous to elevate the buckle without choking off the central retinal artery. In addition, the subretinal fluid may take longer to reabsorb.

Complications

  • Postoperative glaucoma: Angle closure may occur secondary to a detachment and an anterior displacement of the ciliary body. Medical therapy is instituted as required. If this does not work, laser iridotomy followed by laser iridoplasty may be tried to open up the angle.
  • Anterior segment ischemia: Patients at risk are those with sickle cell (SC) hemoglobinopathy and high encircling buckles. Mild cases may respond to topical or systemic steroids, but the encircling band needs to be cut in other cases.
  • Infection and extrusion of the buckle probably occur in 1% of cases. In these cases, the buckle needs to be removed.
  • Choroidal detachments have been reported to occur in as many as 40% of cases. They arise from vortex vein obstruction. Most cases can be followed without drainage.
  • Cystoid macular edema arises from the inflammatory response to the surgical trauma. Its incidence is reported to be around 25% of cases. Its treatment is based on the anti-inflammatory action of corticosteroids and nonsteroidal anti-inflammatory agents.
  • Strabismus following scleral buckling occurs in as many as 50% of cases. It is more common after reoperations. Most cases resolve spontaneously. However, as many as 25% have long-standing diplopia. The main cause is restrictive strabismus. This may be corrected with prisms, botulinum toxin injections, or surgery with adjustable sutures.
  • Macular pucker has been reported in as many as 17% of cases. In some cases, a PPV with membrane peel may be indicated.
  • PVR is the most common cause for surgical failure. In this condition, membranes form on the surface of the retina and in the vitreous cavity. The membranes are composed of cells derived from the RPE, glia, and fibrocytes. The membranes contract and lead to tractional retinal detachment. Risk factors include the number and size of the retinal breaks, the number of previous operations, and the degree of breakdown of the blood-ocular barrier.
  • Persistent subclinical subfoveal fluid has been reported to be present in up to 45% of eyes after successful retinal reattachment with scleral buckling at 6 months and 11% at 12 months.[13] An intravitreal injection of 0.3 mL of SF6 can displace the fluid out of the subfoveal space into the subretinal periphery allowing a quicker visual rehabilitation.[14]

Vitrectomy

Initially, PPV was reserved for complicated retinal detachments, such as giant retinal tears, PVR, and diabetic tractional detachments. Currently, a number of surgeons use it to treat primary uncomplicated retinal detachments.

Most surgeons use a 3-port approach. If axial opacities (eg, lens fragments, vitreous hemorrhage) are present, they are removed.

A central core vitrectomy and removal of the vitreous from the margins of the breaks is the next step.

In a phakic eye, PPV causes a higher incidence of cataract formation than scleral buckling, thus care must be exercised in these maneuvers to prevent accidental damage to the lens. Because of the difficulties in completely relieving vitreoretinal traction without injuring the lens in phakic eyes, some have proposed that vitrectomy is the ideal procedure in pseudophakic and aphakic eyes with RRD.

Drainage of subretinal fluid through a break or through a posterior drainage retinotomy is performed during fluid-air exchange.

Treatment of retinal breaks may be completed with cryotherapy prior to vitrectomy or with laser after the retina is attached. However, post-reattachment retinopexy is probably safer and performed more widely than cryotherapy before reattachment.

On occasion, retinal breaks remain unidentified and thus doom the results of the surgical procedure. Jackson and colleagues have described a new technique for identifying these breaks.[15] This technique involves injection of trypan blue into the subretinal space with subsequent perfluorocarbon liquid assisted extrusion of the dye through the occult breaks.

Intraocular tamponade with either long-acting gas or silicone oil is chosen according to the surgeon's preference. The advantages of gas are that it has a higher surface tension than silicone oil and it disappears on its own. The disadvantage is that it expands with changing atmospheric pressure. Patients with an intraocular gas bubble should not fly. On the hand, silicone oil allows patients to fly but needs to be removed in a second procedure.

The ideal candidates appear to be those with pseudophakia or aphakia or those with phakic eyes with posterior breaks.

Older series by Escoffery et al, Gartry et al, Hakin et al, and Oshima et al report a slightly lower primary reattachment rate than scleral buckling alone.[16, 17, 18, 19] However, one meta-analysis showed that vitrectomy provided more favorable visual outcomes and a higher reattachment rate than scleral buckling in pseudophakic eyes with primary rhegmatogenous retinal detachment.[20]

A retrospective multicentric interventional study reviewed 181 consecutive cases of noncomplex rhegmatogenous retinal detachment who underwent pars plana vitrectomy alone versus pars plana vitrectomy with the addition of a scleral buckle (encircling band). No statistically significant differences were found in the single-surgery success rate, final reattachment rate (after several surgeries), or final visual acuity between the two groups.[21]

Transconjunctival small-gauge vitrectomy has gained popularity in the past few years. 25-gauge transconjunctival vitrectomy was introduced in 2002.[22] Several potential advantages over traditional 20-gauge vitrectomy have been described. These include improved patient comfort, faster wound healing, decreased inflammation, less conjunctival scarring, and a decrease in surgical time in opening and closing.[23] In the beginning, there were certain shortcomings with 25-gauge vitrectomy. These included excessive flexibility of the instruments, poorer illumination, decreased fluidics, and an increase in wound leakage.

The 23-gauge vitrectomy was developed in response to some of these shortcomings.[24] In general, 23-gauge instruments exhibit more rigidity than 25-gauge instruments, which allows performing more peripheral maneuvers. Initially, both 25- and 23-gauge vitrectomy were mostly used in macular cases. However, as surgeons became more familiar and acquainted with both systems, more complex cases were being operated on with transconjunctival small-gauge vitrectomy.

After a review of earlier reports, Heimann concluded that transconjunctival 25- and 23-gauge vitrectomy does not show any advantage over scleral buckling techniques in phakic eyes or 20-gauge vitrectomy in pseudophakic eyes. Furthermore, he claimed that transconjunctival 25- and 23-gauge vitrectomy worsens the outcome and increases the postoperative complication rate.[25]

More recent series suggest otherwise. In a prospective case series of 24 eyes with rhegmatogenous retinal detachment, 23-gauge transconjunctival vitrectomy provided a 91% anatomic success rate. This case series included eyes with complicated retinal detachments with multiple retinal breaks, inferior retinal detachments, giant breaks, concomitant choroidal detachment, vitreous hemorrhage, and secondary macular holes. Thus, their results compare favorably with those reported in the literature for 20-gauge vitrectomy.[26]

In another retrospective case series of 42 eyes with retinal detachment, a 93% one operation anatomic success rate was achieved with transconjunctival 25-gauge vitrectomy.[27] A retrospective study compared the outcomes between eyes operated with 20-gauge and 25-gauge vitrectomy. The authors found no significant differences between 25-gauge and 20-gauge vitrectomy in the repair of primary rhegmatogenous retinal detachment.[28]

Improvements in instrumentation and surgical techniques have made small-gauge transconjunctival vitrectomy the preferred vitrectomy technique for many vitreoretinal surgeons even in complex vitreoretinal cases.

Pneumatic retinopexy

Pneumatic retinopexy is an office procedure where an expanding gas bubble is injected intravitreally through the conjunctiva. The patient is positioned postoperatively to take advantage of the surface tension of the bubble to flatten the retina against the RPE. This closes the break and allows resorption of the subretinal fluid; then, a chorioretinal adhesion surrounding the retinal break can be produced by either laser photocoagulation or cryopexy.

Good candidates are those with single retinal breaks or a group of breaks that do not exceed 1 clock hour and breaks that are confined to the superior two thirds of the fundus. Eyes with PVR grade B or greater are usually excluded. Teenagers can also be treated with this technique, and the overall success rate is similar to that of adults. The success rate is lower in patients with vitreous hemorrhage and detachments greater than 4.5 clock hours. A single procedure with successful reattachment results in better final visual acuity.[29]

Since the gas bubble expands with changing atmospheric pressure, patients should be warned of the perils of flying.

Pneumatic retinopexy can be considered a possible primary alternative to scleral buckling; however, the rates of missed or new retinal breaks are higher in pneumatic retinopexy.

Series by Hilton et al, McAllister et al, and Tornambe et al have reported an anatomical success rate of 80% with a single procedure.[30, 31, 32, 33] When additional surgery is performed, 98% have an anatomical success rate. In eyes with the macula detached for less than 2 weeks, the postoperative visual acuity is better than in those treated with conventional scleral buckling.

Reported complications include subretinal gas, delayed subretinal fluid reabsorption, endophthalmitis, extension of retinal detachment, macular hole formation, PVR, and new retinal breaks.

Lincoff episcleral balloon (Of historical interest only, since they are no longer in the market.)

Good candidates are eyes with single retinal breaks or a group of breaks in a single area. The balloon consists of a catheter with a balloon tip that is expanded with saline injection. Once the balloon is inflated, a scleral buckling effect is produced.

A conjunctival incision is made, and the deflated balloon is introduced into the Tenon space. Then, the balloon is inflated with saline. The balloon is deflated and removed after several days.

The anatomical success rate is about 85% in several series reported by Lincoff et al.[34] Visual results are comparable to those after successful scleral buckling.

Complications are rare, and the most important one is a shift in the location of the balloon. Corneal abrasions can be bothersome to the patient.

Previous
Next

Consultations

Patients with a RRD should be referred to a vitreoretinal specialist immediately.

Previous
Next

Activity

Patients with a rhegmatogenous retinal detachment (RRD) should rest as much as possible prior to surgery. Following surgery, depending on whether an intraocular gas bubble is present, the patient will be instructed to maintain a certain head position.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Lihteh Wu, MD  Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Pan-American Association of Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD  Retina Fellow, St Michael's Hospital, University of Toronto, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

V Al Pakalnis, MD, PhD  Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol. Feb 1982;100(2):289-92. [Medline].

  2. Wilkes SR, Beard CM, Kurland LT, Robertson DM, O'Fallon WM. The incidence of retinal detachment in Rochester, Minnesota, 1970-1978. Am J Ophthalmol. Nov 1982;94(5):670-3. [Medline].

  3. Laatikainen L, Tolppanen EM, Harju H. Epidemiology of rhegmatogenous retinal detachment in a Finnish population. Acta Ophthalmol (Copenh). Feb 1985;63(1):59-64. [Medline].

  4. Tornquist R, Stenkula S, Tornquist P. Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. I. Epidemiology. Acta Ophthalmol (Copenh). Apr 1987;65(2):213-22. [Medline].

  5. Sasaki K, Ideta H, Yonemoto J, Tanaka S, Hirose A, Oka C. Epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan. Graefes Arch Clin Exp Ophthalmol. Dec 1995;233(12):772-6. [Medline].

  6. Wong TY, Tielsch JM, Schein OD. Racial difference in the incidence of retinal detachment in Singapore. Arch Ophthalmol. Mar 1999;117(3):379-83. [Medline].

  7. Wolfensberger TJ, Gonvers M. Optical coherence tomography in the evaluation of incomplete visual acuity recovery after macula-off retinal detachments. Graefes Arch Clin Exp Ophthalmol. Feb 2002;240(2):85-9. [Medline].

  8. Custodis E. Beobachtungen bei der diathermischen Behandlung der Netzhautablosung und ein Minweis zur Therapie der Amotio retinae. Ber Dtsch Ophthalmol Ges. 1952;57:227.

  9. Lincoff HA, Baras I, McLean JM. Modification to the Custodis procedure for retinal detachment. Arch Ophthalmol. 1965;73:160-3.

  10. Schepens CL, Okamura ID, Brockhurst RJ. The scleral buckling procedures. I. Surgical techniques and management. Arch Ophthalmol. 1957;58:797.

  11. Chignell AH. Retinal detachment surgery without drainage of subretinal fluid. Am J Ophthalmol. Jan 1974;77(1):1-5. [Medline].

  12. Lincoff H, Kreissig I. The treatment of retinal detachment without drainage of subretinal fluid. (Modifications of the Custodis procedure. VI). Trans Am Acad Ophthalmol Otolaryngol. Sep-Oct 1972;76(5):1121-33. [Medline].

  13. Wolfensberger TJ. Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery. Ophthalmology. Jul 2004;111(7):1340-3. [Medline].

  14. Itakura H, Kishi S. Intravitreal injection of 0.3 ml of SF6 gas for persistent subfoveal fluid after scleral buckling for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. Aug 2009;247(8):1147-50. [Medline].

  15. Jackson TL, Kwan AS, Laidlaw AH, Aylward W. Identification of retinal breaks using subretinal trypan blue injection. Ophthalmology. Mar 2007;114(3):587-90. [Medline].

  16. Escoffery RF, Olk RJ, Grand MG, Boniuk I. Vitrectomy without scleral buckling for primary rhegmatogenous retinal detachment. Am J Ophthalmol. Mar 15 1985;99(3):275-81. [Medline].

  17. Gartry DS, Chignell AH, Franks WA, Wong D. Pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment uncomplicated by advanced proliferative vitreoretinopathy. Br J Ophthalmol. Apr 1993;77(4):199-203. [Medline].

  18. Hakin KN, Lavin MJ, Leaver PK. Primary vitrectomy for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. Jun 1993;231(6):344-6. [Medline].

  19. Oshima Y, Yamanishi S, Sawa M, Motokura M, Harino S, Emi K. Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment. Jpn J Ophthalmol. Sep-Oct 2000;44(5):538-49. [Medline].

  20. Arya AV, Emerson JW, Engelbert M, Hagedorn CL, Adelman RA. Surgical management of pseudophakic retinal detachments: a meta-analysis. Ophthalmology. Oct 2006;113(10):1724-33. [Medline].

  21. Kinori M, Moisseiev E, Shoshany N, Fabian ID, Skaat A, Barak A, et al. Comparison of pars plana vitrectomy with and without scleral buckle for the repair of primary rhegmatogenous retinal detachment. Am J Ophthalmol. Aug 2011;152(2):291-297.e2. [Medline].

  22. Fujii GY, De Juan E Jr, Humayun MS, Chang TS, Pieramici DJ, Barnes A. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. Oct 2002;109(10):1814-20. [Medline].

  23. Fine HF, Iranmanesh R, Iturralde D, Spaide RF. Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmology. Jun 2007;114(6):1197-200. [Medline].

  24. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. Feb-Mar 2005;25(2):208-11. [Medline].

  25. Heimann H. [Primary 25- and 23-gauge vitrectomy in the treatment of rhegmatogenous retinal detachment--advancement of surgical technique or erroneous trend?]. Klin Monbl Augenheilkd. Nov 2008;225(11):947-56. [Medline].

  26. Tsang CW, Cheung BT, Lam RF, Lee GK, Yuen CY, Lai TY. Primary 23-gauge transconjunctival sutureless vitrectomy for rhegmatogenous retinal detachment. Retina. Oct 2008;28(8):1075-81. [Medline].

  27. Miller DM, Riemann CD, Foster RE, Petersen MR. Primary repair of retinal detachment with 25-gauge pars plana vitrectomy. Retina. Jul-Aug 2008;28(7):931-6. [Medline].

  28. Von Fricken MA, Kunjukunju N, Weber C, Ko G. 25-Gauge sutureless vitrectomy versus 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachment. Retina. Apr 2009;29(4):444-50. [Medline].

  29. Davis MJ, Mudvari SS, Shott S, Rezaei KA. Clinical characteristics affecting the outcome of pneumatic retinopexy. Arch Ophthalmol. Feb 2011;129(2):163-6. [Medline].

  30. Hilton GF, Tornambe PE. Pneumatic retinopexy. An analysis of intraoperative and postoperative complications. The Retinal Detachment Study Group. Retina. 1991;11(3):285-94. [Medline].

  31. McAllister IL, Meyers SM, Zegarra H, Gutman FA, Zakov ZN, Beck GJ. Comparison of pneumatic retinopexy with alternative surgical techniques. Ophthalmology. Jul 1988;95(7):877-83. [Medline].

  32. Tornambe PE, Hilton GF. Pneumatic retinopexy. A multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling. The Retinal Detachment Study Group. Ophthalmology. Jun 1989;96(6):772-83; discussion 784. [Medline].

  33. Tornambe PE, Hilton GF, Brinton DA, et al. Pneumatic retinopexy. A two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling. Ophthalmology. Jul 1991;98(7):1115-23. [Medline].

  34. Lincoff HA, Kreissig I, Hahn YS. A temporary balloon buckle for the treatment of small retinal detachments. Ophthalmology. Apr 1979;86(4):586-96. [Medline].

  35. Wilkinson C. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev. Jan 25 2005;CD003170. [Medline].

  36. Ross WH, Stockl FA. Visual recovery after retinal detachment. Curr Opin Ophthalmol. Jun 2000;11(3):191-4. [Medline].

  37. Henrich PB, Priglinger S, Klaessen D, Kono-Kono JO, Maier M, Schotzau A. Macula-off retinal detachment--a matter of time?. Klin Monbl Augenheilkd. Apr 2009;226(4):289-93. [Medline].

  38. Mowatt L, Tarin S, Nair RG, Menon J, Price NJ. Correlation of visual recovery with macular height in macula-off retinal detachments. Eye (Lond). Feb 2010;24(2):323-7. [Medline].

  39. Day S, Grossman DS, Mruthyunjaya P, Sloan FA, Lee PP. One-year outcomes after retinal detachment surgery among medicare beneficiaries. Am J Ophthalmol. Sep 2010;150(3):338-45. [Medline]. [Full Text].

  40. Amato JE, Akduman L. Incidence of complications in 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications. Ophthalmic Surg Lasers Imaging. Mar-Apr 2007;38(2):100-2. [Medline].

  41. Ambler JS, Meyers SM, Zegarra H, Paranandi L. Reoperations and visual results after failed pneumatic retinopexy. Ophthalmology. Jun 1990;97(6):786-90. [Medline].

  42. Azad RV, Chanana B, Sharma YR, Vohra R. Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment. Acta Ophthalmol Scand. Aug 2007;85(5):540-5. [Medline].

  43. Burton TC. Preoperative factors influencing anatomic success rates following retinal detachment surgery. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. May-Jun 1977;83(3 Pt 1):OP499-505. [Medline].

  44. Burton TC, Lambert RW Jr. A predictive model for visual recovery following retinal detachment surgery. Ophthalmology. Jun 1978;85(6):619-25. [Medline].

  45. Byer NE. Cystic retinal tufts and their relationship to retinal detachment. Arch Ophthalmol. Oct 1981;99(10):1788-90. [Medline].

  46. Byer NE. Long-term natural history of lattice degeneration of the retina. Ophthalmology. Sep 1989;96(9):1396-401; discussion 1401-2. [Medline].

  47. Byer NE. Long-term natural history study of senile retinoschisis with implications for management. Ophthalmology. Sep 1986;93(9):1127-37. [Medline].

  48. Byer NE. Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. Ophthalmology. Sep 1994;101(9):1503-13; discussion 1513-4. [Medline].

  49. Byer NE. The natural history of asymptomatic retinal breaks. Ophthalmology. Sep 1982;89(9):1033-9. [Medline].

  50. Byer NE. What happens to untreated asymptomatic retinal breaks, and are they affected by posterior vitreous detachment?. Ophthalmology. Jun 1998;105(6):1045-9; discussion 1049-50. [Medline].

  51. Campochiaro PA, Kaden IH, Vidaurri-Leal J, Glaser BM. Cryotherapy enhances intravitreal dispersion of viable retinal pigment epithelial cells. Arch Ophthalmol. Mar 1985;103(3):434-6. [Medline].

  52. Chan CK, Wessels IF. Delayed subretinal fluid absorption after pneumatic retinopexy. Ophthalmology. Dec 1989;96(12):1691-700. [Medline].

  53. Chen E. 25-Gauge transconjunctival sutureless vitrectomy. Curr Opin Ophthalmol. May 2007;18(3):188-93. [Medline].

  54. Chen SN, Hwang JF. Treatment of rhegmatogenous retinal detachment in teenagers by pneumatic retinopexy technique. Am J Ophthalmol. Feb 2007;143(2):217-221. [Medline].

  55. Chignell AH, Talbot J. Absorption of subretinal fluid after nondrainage retinal detachment surgery. Arch Ophthalmol. Apr 1978;96(4):635-7. [Medline].

  56. Christensen U, Sander B, Villumsen J. Retinal thickening after successful surgery for macula-off retinal detachment. Curr Eye Res. Jan 2007;32(1):65-9. [Medline].

  57. Clarkson JG, Blumenkranz MS, Culbertson WW, Flynn HW Jr, Lewis ML. Retinal detachment following the acute retinal necrosis syndrome. Ophthalmology. Dec 1984;91(12):1665-8. [Medline].

  58. Dieckert JP, O'Connor PS, Schacklett DE, et al. Air travel and intraocular gas. Ophthalmology. May 1986;93(5):642-5. [Medline].

  59. Diederen RM, La Heij EC, Kessels AG, Goezinne F, Liem AT, Hendrikse F. Scleral buckling surgery after macula-off retinal detachment: worse visual outcome after more than 6 days. Ophthalmology. Apr 2007;114(4):705-9. [Medline].

  60. Dominguez DA. Cirugia precoz y ambulatoria del desprendimiento de retina. Arch Soc Esp Oftalmol. 1985;48:47.

  61. Foos RY. Posterior vitreous detachment. Trans Am Acad Ophthalmol Otolaryngol. Mar-Apr 1972;76(2):480-97. [Medline].

  62. Foos RY, Wheeler NC. Vitreoretinal juncture. Synchysis senilis and posterior vitreous detachment. Ophthalmology. Dec 1982;89(12):1502-12. [Medline].

  63. Freeman WR, Henderly DE, Wan WL, Causey D, Trousdale M, Green RL, et al. Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol. Apr 15 1987;103(4):527-36. [Medline].

  64. Fujii GY, De Juan E Jr, Humayun MS, Pieramici DJ, Chang TS, Awh C. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. Oct 2002;109(10):1807-12; discussion 1813. [Medline].

  65. Goldmann H. Zur Biomikroskopie des Glaskorpers. Ophthalmologica. 1954;127:334.

  66. Hilton GF, Grizzard WS. Pneumatic retinopexy. A two-step outpatient operation without conjunctival incision. Ophthalmology. May 1986;93(5):626-41. [Medline].

  67. Holland GN. Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society. Am J Ophthalmol. May 15 1994;117(5):663-7. [Medline].

  68. Holland SP, Pulido JS, Miller D, et al. Biofilm and scleral buckle-associated infections. A mechanism for persistence. Ophthalmology. Jun 1991;98(6):933-8. [Medline].

  69. Kanski JJ, Elkington AR, Davies MS. Diplopia after retinal detachment surgery. Am J Ophthalmol. Jul 1973;76(1):38-40. [Medline].

  70. Kawahara S, Nagai Y, Kawakami E, Ida RY, Takeuchi M, Uyama M. Ciliochoroidal Detachment Following Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment. Jpn J Ophthalmol. Nov 1 2000;44(6):692-693. [Medline].

  71. Kon CH, Asaria RH, Occleston NL, Khaw PT, Aylward GW. Risk factors for proliferative vitreoretinopathy after primary vitrectomy: a prospective study. Br J Ophthalmol. May 2000;84(5):506-11. [Medline].

  72. La Heij EC, Derhaag PF, Hendrikse F. Results of scleral buckling operations in primary rhegmatogenous retinal detachment. Doc Ophthalmol. 2000;100(1):17-25. [Medline].

  73. Li X. Incidence and epidemiological characteristics of rhegmatogenous retinal detachment in Beijing, China. Ophthalmology. Dec 2003;110(12):2413-7. [Medline].

  74. Lincoff HA, Mclean JM, Nano H. CRYOSURGICAL TREATMENT OF RETINAL DETACHMENT. Trans Am Acad Ophthalmol Otolaryngol. May-Jun 1964;68:412-32. [Medline].

  75. Lobes LA Jr, Burton TC. The incidence of macular pucker after retinal detachment surgery. Am J Ophthalmol. Jan 1978;85(1):72-7. [Medline].

  76. Lobes LA Jr, Grand MG. Incidence of cystoid macular edema following scleral buckling procedure. Arch Ophthalmol. Jul 1980;98(7):1230-2. [Medline].

  77. Mastropasqua L, Carpineto P, Ciancaglini M, Falconio G, Gallenga PE. Treatment of retinal tears and lattice degenerations in fellow eyes in high risk patients suffering retinal detachment: a prospective study. Br J Ophthalmol. Sep 1999;83(9):1046-9. [Medline].

  78. McDonald HR, Abrams GW, Irvine AR, et al. The management of subretinal gas following attempted pneumatic retinal reattachment. Ophthalmology. Apr 1987;94(4):319-26. [Medline].

  79. Meredith TA, Reeser FH, Topping TM, Aaberg TM. Cystoid macular edema after retinal detachment surgery. Ophthalmology. Nov 1980;87(11):1090-5. [Medline].

  80. Oshima Y, Emi K, Motokura M, Yamanishi S. Survey of surgical indications and results of primary pars plana vitrectomy for rhegmatogenous retinal detachments. Jpn J Ophthalmol. Mar-Apr 1999;43(2):120-6. [Medline].

  81. Packer AJ, Maggiano JM, Aaberg TM, Meredith TA, Reeser FH, Kingham JD. Serous choroidal detachment after retinal detachment surgery. Arch Ophthalmol. Aug 1983;101(8):1221-4. [Medline].

  82. Perez RN, Phelps CD, Burton TC. Angel-closure glaucoma following scleral buckling operations. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. Mar-Apr 1976;81(2):247-52. [Medline].

  83. Richardson EC, Verma S, Green WT, Woon H, Chignell AH. Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of failure. Eur J Ophthalmol. Apr-Jun 2000;10(2):160-6. [Medline].

  84. Rizzo S, Genovesi-Ebert F, Murri S, et al. 25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study. Graefes Arch Clin Exp Ophthalmol. Apr 2006;244(4):472-9. [Medline].

  85. Ryan SJ, Goldberg MF. Anterior segment ischemia following scleral buckling in sickle cell hemoglobinopathy. Am J Ophthalmol. Jul 30 1971;72(1):35-50. [Medline].

  86. Saw SM, Gazzard G, Wagle AM, Lim J, Au Eong KG. An evidence-based analysis of surgical interventions for uncomplicated rhegmatogenous retinal detachment. Acta Ophthalmol Scand. Oct 2006;84(5):606-12. [Medline].

  87. Schepens CL, Marden D. Data on the natural history of retinal detachment. I. Age and sex relationships. Arch Ophthalmol. 1961;66:631.

  88. Schwartz SG, Flynn HW. Primary retinal detachment: scleral buckle or pars plana vitrectomy?. Curr Opin Ophthalmol. Jun 2006;17(3):245-50. [Medline].

  89. Smiddy WE, Loupe D, Michels RG, Enger C, Glaser BM, deBustros S. Extraocular muscle imbalance after scleral buckling surgery. Ophthalmology. Oct 1989;96(10):1485-9; discussion 1489-90. [Medline].

  90. Smiddy WE, Loupe DN, Michels RG, Enger C, Glaser BM, deBustros S. Refractive changes after scleral buckling surgery. Arch Ophthalmol. Oct 1989;107(10):1469-71. [Medline].

  91. Spencer LM, Foos RY, Straatsma BR. Enclosed bays of the ora serrata. Relationship to retina tears. Arch Ophthalmol. Apr 1970;83(4):421-5. [Medline].

  92. Tanner V, Harle D, Tan J, Foote B, Williamson TH, Chignell AH. Acute posterior vitreous detachment: the predictive value of vitreous pigment and symptomatology. Br J Ophthalmol. Nov 2000;84(11):1264-8. [Medline].

  93. Tillery WV, Lucier AC. Round atrophic holes in lattice degeneration--an important cause of phakic retinal detachment. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. May-Jun 1976;81(3 Pt 1):509-18. [Medline].

  94. Wilkinson CP. Evidence-based medicine regarding the prevention of retinal detachment. Trans Am Ophthalmol Soc. 1999;97:397-404; discussion 404-6. [Medline].

  95. Wilkinson CP, Bradford RH Jr. Complications of draining subretinal fluid. Retina. Winter-Spring 1984;4(1):1-4. [Medline].

  96. Wright LA, Cleary M, Barrie T, Hammer HM. Motility and binocularity outcomes in vitrectomy versus scleral buckling in retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol. Dec 1999;237(12):1028-32. [Medline].

  97. Yeo JH, Vidaurri-Leal J, Glaser BM. Extension of retinal detachments as a complication of pneumatic retinopexy. Arch Ophthalmol. Aug 1986;104(8):1161-3. [Medline].

 
Previous
Next
 
Clinical picture of a rhegmatogenous retinal detachment involving the macula. Notice the folds just temporal to the fovea.
Clinical picture of a rhegmatogenous retinal detachment. Notice that the macula is involved and that the retina is corrugated and has a slightly opaque color.
This patient had a vitreous hemorrhage that prevented visualization of the retina. A B-scan ultrasound reveals a retinal detachment.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.