[Highly restricted detachment surgery without puncture: long-term results on the topic of postoperative "residual detachment" and late re-detachment].

BACKGROUND

Detachment surgery without drainage, a surgery limited to area of break, implies minimization of procedure and complications. In a 1st study (1970-1977) 1,000 consecutive detachments were treated with favorable results (primary reattachment in 83%, after reoperation in 91%, follow-up 4 months-7 1/2 years). A prospective 2nd study (8/1979-1/1980) followed to answer the questions: (1) Differential diagnosis between postoperative "residual detachments" and surgical failure. (2) Is rate of "late" redetachment after minimal segmental buckling greater than after cerclage?

PATIENTS AND

METHODS

Prospective study of 107 detachments operated 8/1979-1/1980 with follow-up of 11-11 1/2 years. Detachments: 21 eyes with aphakia, 1 with pseudophakia, 16 with PVR stage C1/C2.

TREATMENT: cryopexy and segmental buckling or balloon in area of break without drainage, no vitrectomy, no cerclage. Orientation of buckles: 76 radials, 20 circumferentials, 11 radials with circumferentials.

RESULTS

After 1 operation retina was reattached in 99 eyes (92.6%), after reoperation of primary failure (confined to original or to previously undetected break) the retina reattached in 104 eyes (97%). Types of postoperative "residual detachments" after non-drainage: (1) convex residual detachment (delayed absorption) or (2) concave residual detachment (traction), both of them with no hole (to observe) and (3) convex residual rhegmatogenous detachment (to reoperate). Longterm results (follow-up 11 years) of 104 reattached retinas: "early" redetachment (2-4 months postoperatively) in 6 eyes or 5.6% because of PVR and "late" redetachment (3 to 7 years postoperatively) in 7 eyes or 6.5% because of new breaks. After reoperation reattachment in 99 eyes (92.6%); only 1 of 107 eyes had 2 reoperations. Reasons for final failure: PVR (3.7%), no hole found (2.8%), massive choroidals (0.9%).

CONCLUSION

After detachment surgery without drainage there can be: (1) convex or (2) concave "residual" detachment and (3) rhegmatogenous residual detachment with new contour (reoperation needed). Favorable longterm results after minimal surgery (6.5% "late" redetachment during 11 years postoperatively) and use of minimal surgery as reoperation (50% a balloon) for reattaching the retina do not support the necessity of a prophylactic cerclage as primary operation, even not as reoperation per se. A simple alternative to a surgical prophylaxis represents a so-called "passive" prophylaxis consisting in explaining the visual field to the patient and asking him to test it regularly.