AUTHOR AND EDITOR INFORMATION

Section 1 of 10  

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• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Follow-up
• Miscellaneous
• Multimedia
• References

INTRODUCTION

Section 2 of 10  

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Background

Retinal detachment occurs when subretinal fluid accumulates in the potential space between the neurosensory retina and the underlying retinal pigment epithelium (RPE). Depending on the mechanism of subretinal fluid accumulation, retinal detachments traditionally have been classified into rhegmatogenous, tractional, and exudative.

The term rhegmatogenous is derived from the Greek word rhegma, which means a discontinuity or a break. A rhegmatogenous retinal detachment (RRD) occurs when a tear in the retina leads to fluid accumulation with a separation of the neurosensory retina from the underlying RPE; this is the most common type of retinal detachment.

Pathophysiology

Vitreoretinal traction is responsible for the occurrence of most RRD. As the vitreous becomes more syneretic (liquefied) with age, a posterior vitreous detachment (PVD) occurs. In most eyes, the vitreous gel separates from the retina without any sequelae. However, in certain eyes, strong vitreoretinal adhesions are present and the occurrence of a PVD can lead to a retinal tear formation; then, fluid from the liquefied vitreous can seep under the tear, leading to a retinal detachment.

A number of conditions exist that predispose to a PVD by prematurely accelerating the liquefaction of the vitreous gel. Myopia, aphakia or pseudophakia, familial conditions, and inflammation are among the common causes. In other cases, retinal necrosis with a retinal break formation occurs; then, fluid from the vitreous cavity can flow through the breaks and detach the retina without there being overt vitreoretinal traction present. This commonly occurs in acute retinal necrosis syndrome and in cytomegalovirus (CMV) retinitis in AIDS patients.

Frequency

United States

According to population-based studies in Iowa by Haimann et al and in Minnesota by Wilkes et al, the annual incidence of RRD is 12 cases per 100,000.^{1, 2}

International

Scandinavian studies by Laatikainen et al and Tornquist et al reveal an annual incidence of RRD of 7-10 cases per 100,000.^{3, 4}

A Japanese study by Sasaki et al reported an annual incidence of RRD of 10.4 cases per 100,000.⁵

A study from Singapore by Wong et al reported annual incidences of RRD of 11.6 cases per 100,000 in the Chinese population, 7 cases per 100,000 in the Malay population, and 3.9 cases per 100,000 in the Indian population.⁶

A study from Beijing, China, estimated the annual incidence of RRD to be 7.98 cases per 100,000.

Mortality/Morbidity

Visual results depend on the preoperative macular status. Most series report an anatomical success rate of 90-95%. Of the eyes that are successfully reattached, about 50% obtain a final visual acuity of 20/50 or better. In eyes where the macula was attached prior to surgery, as many as 10% have some vision loss despite successful surgery. In most cases, this decrease in vision is caused by cystoid macular edema and macular pucker.

Sex

RRD appears to be more common in males than in females.

Age

Most RRDs occur in persons aged 40-70 years. It is at this time that the syneretic vitreous undergoes separation from the retina.

CLINICAL

Section 3 of 10  

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• Workup
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• Miscellaneous
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• References

History

• Specifically ask patients about risk factors that predispose to premature PVD.
• • Myopia
  • Prior intraocular surgery
  • Family history
  • RRD in the fellow eye
• Symptoms
• • Photopsias refer to the perception of flashing lights by the patient. It probably arises from the mechanical stimulation of vitreoretinal traction on the retina. It may be induced by eye movements and appears to be more noticeable in dim illumination.
  • Visual field defect: Patients often describe a black curtain (visual field defect) once the subretinal fluid extends posterior to the equator.
  • Floaters
  • • Floaters are opacities in the vitreous that cast a dark shadow according to their form and shape in the patient's visual field as they float in the vitreous cavity.
    • A ring-shaped floater is the Weiss ring or the remnant of the hyaloid that was attached to the edges of the optic disc.
    • Cobwebs are caused by condensation of the collagen fibers.
    • Small spots usually indicate fresh blood due to the rupture of a retinal vessel during an acute PVD.
  • Loss of central vision
  • • When the macula becomes detached (ie, extension of subretinal fluid into the macula), the patient experiences a drop in visual acuity.
    • In other cases, a large bullous detachment may obstruct the macula, causing decreased visual acuity despite the fact that the macula is not detached.

Physical

• Cell and flare may be seen in the anterior chamber of eyes with a RRD.
• The intraocular pressure is usually lower in the eye with a RRD than in the fellow eye; this is usually reversed by retinal reattachment. In certain cases, the intraocular pressure may be higher than in the fellow eye.
• Pigment in the anterior vitreous (tobacco dusting or a Shaffer sign) is usually present.
• Once the retina becomes detached, it assumes a slightly opaque color secondary to intraretinal edema. It has a convex configuration, has a corrugated appearance, and undulates freely with eye movements unless severe proliferative vitreoretinopathy (PVR) is present.
• A retinal break in the shape of a horseshoe or flap is often present. Of all RRDs, 50% have more than 1 break. Of all breaks, 60% are located in the upper temporal quadrant, and 15% are located in the upper nasal quadrant. Another 15% are in the lower temporal quadrant, and 10% are in the lower nasal quadrant.
• Chronic RRD may present with retinal thinning, intraretinal cysts, subretinal fibrosis, and demarcation lines. These lines are usually at the junction of attached and detached retina. Even though they represent areas of increased retinal adhesion to the RPE, it is not uncommon for subretinal fluid to spread beyond the lines.

Causes

• The main cause of a RRD is a PVD that leads to retinal tear formation. The following are risk factors that commonly share the premature liquefaction of the vitreous gel leading to an increased rate of PVD.
• • Abnormal vitreoretinal adhesions, which may be visible or invisible, are present in many eyes. Among the visible ones are enclosed oral bays, lattice degeneration, and cystic retinal tufts. When a PVD occurs and encounters such an area, a retinal tear may form.
  • Prior intraocular surgery, especially cataract extraction: It appears that an intact posterior capsule delays the onset of PVD. Other procedures, such as penetrating keratoplasty and pars plana vitrectomy (PPV), also may be complicated by a RRD.
  • Certain familial conditions, such as Stickler syndrome, Marfan syndrome, homocystinuria, and Ehlers-Danlos syndrome, are associated with RRD.
  • Inflammatory or infectious conditions, such as acute retinal necrosis syndrome, CMV retinitis in AIDS patients, ocular toxoplasmosis, and pars planitis
  • Axial myopia

DIFFERENTIALS

Section 4 of 10  

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• Clinical
• Differentials
• Workup
• Treatment
• Follow-up
• Miscellaneous
• Multimedia
• References

WORKUP

Section 5 of 10  

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• Differentials
• Workup
• Treatment
• Follow-up
• Miscellaneous
• Multimedia
• References

Imaging Studies

• Ultrasound
• • On certain occasions, the media may not be clear, impairing a thorough retinal examination with the binocular indirect ophthalmoscope. An ultrasound is a useful adjunct in these situations.
  • Ultra–high-frequency sounds travel to the back of the eye as the probe emits them. Once a structure is contacted by the sound waves, the sound wave is attenuated and reflected back to the probe. The pattern of these waves is specific for certain tissues. Thus, localization and tissue characterization is possible using this technique. Typically, an A scan and a B scan are obtained. For instance, retinal tissue usually shows a large spike in the A scan, reflecting an increased acoustic density of the tissue. The B scan shows a composite picture of the globe and its intraocular contents.
  • Sometimes, it may be difficult to differentiate a retinal detachment from a thickened, partially detached posterior hyaloid. In this case, A-scan and B-scan findings often overlap. Tissue mobility during scanning may help to differentiate the two. Usually, a RRD has a characteristic undulating motion after a sudden saccade, whereas a thickened posterior hyaloid moves in a brisker manner but with less excursion.
• Fluorescein angiography (FA): Cystoid macular edema may complicate the postoperative course of an eye that has undergone retinal reattachment surgery. FA is a useful adjunct in helping to diagnose this condition.
• Optical coherence tomography (OCT): Occasionally, certain eyes appear to have complete retinal reattachment, but the visual acuity appears to be incomplete or delayed. OCT helps to reveal subfoveal fluid in these eyes.

Other Tests

• Electroretinogram (ERG): When a patient presents with a dense vitreous hemorrhage or a cataract that precludes direct visualization of the retina, an ultrasound of the posterior pole is indicated. Sometimes, differentiating a RRD and a thickened posterior hyaloid that is partially detached using ultrasound is difficult. In these circumstances, an ERG is a useful adjunct in the evaluation of a patient suspected of having a RRD. If a good response from the ERG is obtained, the retina is probably attached. If the electric response from the retina is attenuated to a great degree, the retina is probably detached.

Histologic Findings

During separation of the neurosensory retina from the RPE, the choroidal blood flow to the outer retinal layers is lost. The RPE also loses its ability to modulate the health of the outer segments of the photoreceptors. Initially, the outer segments of the photoreceptors are lost. After successful retinal reattachment, the outer segments may regenerate. As the detachment becomes more chronic, atrophy of the entire photoreceptor layer, cystic degeneration, macrocyst formation, demarcation lines, and even rubeosis iridis may be seen.

TREATMENT

Section 6 of 10  

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Medical Care

No role exists for medical care in the treatment of RRDs.

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.^{7, 8}
    • 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.⁹
    • 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.^{10, 11} 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.
• 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.
  • 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.
  • 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.^{12, 13, 14, 15}
• 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.
  • 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.^{16, 17, 18, 19} 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.²⁰ 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.

Consultations

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

Activity

Patients with a 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.

FOLLOW-UP

Section 7 of 10  

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Further Inpatient Care

• Currently, most vitreoretinal surgery is performed as an outpatient procedure.

Further Outpatient Care

• Depending on the presence or absence of an intraocular gas bubble, the patient will be instructed to maintain a certain head position.

In/Out Patient Meds

• Following surgery, most surgeons elect to place the patient on a topical antibiotic for prophylaxis for 7-10 days, a cycloplegic agent (eg, atropine 1%) for about 1 month, and a topical steroid (eg, prednisolone acetate 1%) also for about 1 month. The intraocular pressure is monitored during the postoperative period and treated as necessary.

Deterrence/Prevention

• The principal cause of a RRD is the formation of a retinal break following a PVD.
• • To prevent a RRD from occurring, one could try to find a way to prevent vitreous syneresis or PVD. So far, no such prevention method is available.
  • Another strategy would be to relieve vitreoretinal traction. Currently, the only known way to do this is through surgery (ie, scleral buckle, vitrectomy). However, the risks of these procedures do not justify their use in the prevention of a RRD.
  • The third strategy is to create chorioretinal adhesions around retinal breaks and other visible predisposing lesions. One must take into account whether other risk factors are present (eg, myopia, fellow eye RRD, family history, previous cataract surgery) and whether the patient is symptomatic. On one hand, asymptomatic patients with visible lesions (eg, lattice) probably have a very low risk of retinal detachment. These patients can be observed without treatment. On the other hand, myopic, pseudophakic patients with a RRD in the fellow eye with visible lesions should be strongly considered for prophylactic treatment.
• Whether laser treatment is in fact beneficial in preventing a RRD in fellow eyes is not known. However, the adverse effects are minimal and the potential benefits are great. One must caution the patient that despite prophylactic treatment, a retinal tear may still occur. On the other hand, Wilkinson concluded that no conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks and/or lattice degeneration.²¹

Complications

• PVR is the most common reason for surgical failure.
• Rubeosis iridis

Prognosis

• Retinal reattachment surgery has improved over the past few decades. Currently, as many as 95% of patients can have an anatomical success. Visual prognosis depends on whether the macula is attached at the time of surgery. Once the macula is detached, the photoreceptors start to degenerate, impairing the visual recovery. It is believed that only 50% of patients reach a visual acuity of 20/50 or better.

Patient Education

• Warn patients who experience a retinal detachment of the potential risk to the fellow eye. In phakic eyes, the risk is estimated to be 10-15%. In aphakic or pseudophakic eyes, the risk increases to 25-40%.
• Instruct patients to seek attention immediately if they start experiencing floaters and/or photopsias.

MISCELLANEOUS

Section 8 of 10  

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• Miscellaneous
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Medical/Legal Pitfalls

• Since most general ophthalmologists do not repair retinal detachments on their own, it is imperative that the patient is referred to a vitreoretinal specialist immediately.
• When discussing possible cataract surgery or YAG capsulotomy, the risk of retinal detachment must be revealed to the patient.

MULTIMEDIA

Section 9 of 10  

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Media file 1:  Clinical picture of a rhegmatogenous retinal detachment involving the macula. Notice the folds just temporal to the fovea.
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Media file 2:  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.
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Media type:  Photo

Media file 3:  This patient had a vitreous hemorrhage that prevented visualization of the retina. A B-scan ultrasound reveals a retinal detachment.
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Media type:  Photo

REFERENCES

Section 10 of 10

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• 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].
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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. Custodis E. Beobachtungen bei der diathermischen Behandlung der Netzhautablosung und ein Minweis zur Therapie der Amotio retinae. Ber Dtsch Ophthalmol Ges. 1952;57:227.
8. Lincoff HA, Baras I, McLean JM. Modification to the Custodis procedure for retinal detachment. Arch Ophthalmol. 1965;73:160-3.
9. Schepens CL, Okamura ID, Brockhurst RJ. The scleral buckling procedures. I. Surgical techniques and management. Arch Ophthalmol. 1957;58:797.
10. Chignell AH. Retinal detachment surgery without drainage of subretinal fluid. Am J Ophthalmol. Jan 1974;77(1):1-5. [Medline].
11. 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].
12. 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].
13. 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].
14. Hakin KN, Lavin MJ, Leaver PK. Primary vitrectomy for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. Jun 1993;231(6):344-6. [Medline].
15. 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].
16. 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].
17. 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].
18. 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].
19. Tornambe PE, Hilton GF, Brinton DA, Flood TP, Green S, Grizzard WS, 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].
20. 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].
21. Wilkinson C. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev. 2005;(1):CD003170. [Medline].
22. 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].
23. Ambler JS, Meyers SM, Zegarra H, Paranandi L. Reoperations and visual results after failed pneumatic retinopexy. Ophthalmology. Jun 1990;97(6):786-90. [Medline].
24. 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].
25. 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].
26. Burton TC, Lambert RW Jr. A predictive model for visual recovery following retinal detachment surgery. Ophthalmology. Jun 1978;85(6):619-25. [Medline].
27. Byer NE. Cystic retinal tufts and their relationship to retinal detachment. Arch Ophthalmol. Oct 1981;99(10):1788-90. [Medline].
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Article Last Updated: Aug 2, 2007