Table Of ContentI
A Practical Guide to
MinimalSurgeryforRetinalDetachment
II
III
A Practical Guide to
Minimal Surgery for
Retinal Detachment
Volume1
Diagnostics · Segmental Buckling without Drainage ·
Case Presentations
Ingrid Kreissig, M.D.
ProfessorandChairman
OphthalmologyIII:RetinaandVitreousSurgery
TuebingenUniversity,Germany
AdjunctProfessorofClinicalOphthalmology
WeillMedicalCollegeofCornellUniversity−NewYorkPresbytarian
Hospital,NewYork,USA
176Illustrations
Thieme
Stuttgart · New York 2000
IV
LibraryofCongressCataloging-in-Publica-
tionData Important Note: Medicine is an ever-
changingscienceundergoingcontinual
Kreissig,Ingrid. development.Researchandclinicalex-
APracticalGuidetoMinimalSurgery periencearecontinuallyexpandingour
forRetinalDetachment/IngridKreissig. knowledge,inparticularourknowledge
p.;cm. ofpropertreatmentanddrugtherapy.
Includesbibliographicalreferencesand Insofar as this book mentions any
index. dosageorapplication,readersmayrest
ISBN3131110619−ISBN0-86577-781-0 assured that the authors, editors, and
1.Retinaldetachment−Surgery.I.Title. publishershavemadeeveryefforttoen-
[DNLM:1.RetinalDetachment− surethatsuchreferencesareinaccor-
dancewiththestateofknowledgeatthe
surgery.2.RetinalDetachment−diagno-
timeofproductionofthebook.
sis.3.SurgicalProcedures,Minimalex-
Nevertheless, this does not involve,
traocularmethods. WW270K91h imply,orexpressanyguaranteeorre-
1999] sponsibilityonthepartofthepublishers
RE603.K74 1999 inrespecttoanydosageinstructionsand
617.7’.35059—dc21 formsofapplicationstatedinthebook.
99-044473 Everyuserisrequestedtoexaminecare-
fullythemanufacturer’sleafletsaccom-
panyingeachdrugandtocheck,ifnec-
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orspecialist,whetherthedosagesched-
ulesmentionedthereinorthecontrain-
dications stated by the manufacturers
differfromthestatementsmadeinthe
presentbook.Suchexaminationispar-
ticularlyimportantwithdrugsthatare
eitherrarelyusedorhavebeennewly
released on the market. Every dosage
schedule or every form of application
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andresponsibility.Theauthorsandpub-
lishers request every user to report to
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turersorspecificbrandnamesshouldnotbe
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V
ToHarvey,
oneofthemostperceptivethinkersinthisfield,
whohasinspiredmyenthusiasmforretinalsurgery
forover30yearsnow.
Heistheonewhoshouldhavewrittenthisbook.
VI
Acknowledgements
IwishtoexpressmyutmostgratitudetoProfessorLincoff,asuperb
teacher,researcher,andclinician,whoprovidedmewithconstant
supportduringmyretinalwork.Inaddition,Iwouldliketothankall
myotherteachers,mystudents,thephysicianswhohavereferred
theirpatientstomefordiagnosticsandtreatment,andthevarious
ophthalmologists from East and West who trained with me and
challengedmewithcritical,butvaluablequestions.
Most of all my gratitude is extended to my family and to
thoseverygoodfriends—nearandfar—whogavemetheirfullcon-
siderationandsupportwhileIwaswritingthisbook.
MyparticularthanksalsogotoMrsKeller,whoindefatigably
typedandeditedthemanuscriptwithoptimumcooperation,andto
MrsJanywhoprovidedthecomputerimages.Thelayoutofthetext—
offering a didactic approach—as well as the quality of the figures
can be attributed to the special efforts of Mr Rainer Hurler, a
talentedcompositor,towhomIamverymuchindebted.
Finally,IwouldliketothankthestaffatThieme,inparticular
MrKruegerandDrBergman,forrealizingthisproject.
VII
Preface
Thisbookisintendedtobehandytouseandeasytounderstand.It
isbasedonmanyyearsofteachingandresearchinretinalsurgery.It
analyzes diagnostic methods, differential diagnosis, and ways of
achieving minimal extraocular surgery in the treatment of retinal
detachment,fromthelearner’spointofview.
Thebookiswrittenindialoguestylesoastoencouragecriti-
calandoriginalthinking.Itreflectseverydaypractice,andoffersa
hands-onguidetominimalretinalsurgery.
Tuebingen,Fall1999 IngridKreissig
VIII
Contents
1 RhegmatogenousRetinalDetachment.................... 1
1.1 Introduction....................................... 2
1.2 VitreousBody ..................................... 2
1.3 PrecursorsofRhegmatogenousRetinalDetachment . 2
1.4 CharacteristicsofRhegmatogenousRetinal
Detachment ....................................... 3
Referenc.e.s.......................................... 6
2 PreoperativeExamination ............................... 7
2.1 HowtoFindtheBreakorBreaks ................... 8
2.2 The4RulestoFindthePrimaryBreak .............. 13
2.2.1 SuperiorTemporalorNasalDetachments .... 13
2.2.2 TotalorSuperiorDetachmentsthatCrossthe
12o’ClockMeridian ........................ 16
2.2.3 InferiorDetachments ....................... 17
2.2.4 “Inferior”BullousDetachments .............. 17
2.3 SomeSpecialTypesofDetachment ................. 18
2.3.1 InferiorDetachmentwithaHoleat6o’Clock. 18
2.3.2 InferiorDetachmentinPresenceofaBuckle . 20
2.3.3 “Total”Detachment ......................... 20
2.3.4 MixedDetachmentwithConvexandConcave
Components................................ 23
2.4 Summary ......................................... 25
3 AcuteRhegmatogenousVitreousHemorrhage ............ 27
3.1 PrecursorsofRetinalDetachmentinthePresence
ofVitreousHemorrhage ........................... 28
3.2 TopographyofAcute“Vitreous”Hemorrhage........ 28
3.3 ConservativeManagement ......................... 30
3.4 ClinicalStudyandResults .......................... 37
3.5 Summary ......................................... 39
Referenc.e.s.......................................... 40
Contents IX
4 RhegmatogenousRetinalDetachment“without”aBreak.. 41
4.1 CharacteristicsofaRhegmatogenousRetinal
Detachment ....................................... 42
4.2 OpticalProblemsintheSearchfortheRetinalBreak. 43
4.2.1 HazyMedia ................................ 43
4.2.2 PupillaryObstruction ....................... 43
4.3 TechniquesforFindingaTinyBreak ................ 45
4.3.1 DefinetheBordersoftheRetinal
Detachment ................................ 45
4.3.2 UseSpecialMagnification ................... 45
4.4 IntraoperativeTechniquesforFindingaTinyBreak .. 46
4.4.1 Re-studytheRetinalPeriphery
withDepression ............................ 46
4.4.2 DiagnosticFreezingatSpecialPoints......... 47
4.4.3 DiagnosticBalloonintheAreaofSuspicion .. 47
4.4.4 ProspectiveSegmentalBuckling ............. 48
4.4.5 DiagnosticExpandingGasBubble
(DescendingorAscending) .................. 53
4.4.6 VitrectomyinConjunctionwithHeavy
PerfluorocarbonLiquids ..................... 58
4.5 Summary ......................................... 59
Referenc.e.s.......................................... 60
5 DifferentialDiagnosis:Rhegmatogenousversus
NonrhegmatogenousRetinalDetachments ............... 63
5.1 PeripheralRetinalElevations ...................... 64
5.1.1 CystoidDegeneration ....................... 64
5.1.2 DegenerativeRetinoschisis .................. 66
5.1.3 Edema ..................................... 69
5.2 CentralElevations ................................. 71
5.2.1 MacularFull-ThicknessversusLamellarHole . 71
5.2.2 IschemicEdema ............................ 73
5.2.3 OpticPitMaculopathy ...................... 75
5.2.4 TractionalRetinalDetachment .............. 76
5.2.5 TractionalRetinalSchisis.................... 80
5.2.6 ClinicalStudy .............................. 82
5.3 DependentRetinalElevations ...................... 82
5.3.1 ExudativeDetachments ..................... 82
Referenc.e.s.......................................... 85
