RETINAL DETACHMENT

Principles and Practice

Third Edition

Daniel A. Brinton, MD, and C. P. Wilkinson, MD

Published by Oxford University Press

In cooperation with

The American Academy of Ophthalmology

1

2009

1

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Copyright © 2009 by Daniel A. Brinton and C. P. Wilkinson

Published by Oxford University Press, Inc.

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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise,

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Library of Congress Cataloging-in-Publication Data Brinton, Daniel A., 1955-

Retinal detachment : principles and practice / Daniel A. Brinton and C.P. Wilkinson. — 3rd ed. p. ; cm. — (Ophthalmology monographs ; 1)

Rev. ed. of: Retinal detachment / George F. Hilton, Edward B. McLean, Daniel A. Brinton. 2nd ed. 1995. Includes bibliographical references and index.

ISBN 978-0-19-533082-3

1.Retinal detachment. 2. Retinal detachment—Surgery. I. Wilkinson, C. P.

II. Hilton, George F. Retinal detachment. III. American Academy of Ophthalmology. IV. Title. V. Series.

[DNLM: 1. Retinal Detachment. W1 OP372L v.1 2009 / WW 270 B8585r 2009] RE603.H543 2009

617.7’3—dc22

2008041403

9 8 7 6 5 4 3 2 1

Printed in the United States of America on acid-free paper

Legal Notice

Because diagnostic, therapeutic, and practice recommendations (hereinafter “recommendations”) may have changed since the publication of this book, because such recommendations cannot be considered absolute or universal in their application, and because the publication process contains the potential for error, Oxford University Press strongly advises that the recommendations in this book be verified, prior to use, with information included in the manufacturers’ package inserts or provided by an independent source, and that they be considered in light of a particular patient’s clinical condition and history. Caution is especially urged when using infrequently used or unfamiliar drugs or treatments. Including all indications, contraindications, side effects, and alternative agents for each drug or treatment is beyond the scope of this book.

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v

Preface

Originally written on assignment from the American Academy of Ophthalmology, this monograph is now updated under ownership of Oxford University Press. This edition constitutes a substantial reorganization with large amounts of new material. It is a thorough revision with emphasis on conciseness.

Rather than document each point with specific references to the literature, a list of Selected References is included at the end of each chapter for those who would like to pursue further research.

The work is based on a review of the literature and on our personal experience. We have attempted to acknowledge controversy where it exists, and to present alternative points of view. The monograph is sufficiently brief to encourage cover- to-cover reading, but it has a detailed table of contents and an index to facilitate locating specific information. The book is not an all-inclusive treatise; rather, it is intended as an introduction to retinal detachment for the ophthalmology resident or as a concise review and reference manual for the practicing ophthalmologist.

Daniel A. Brinton, MD

C. P. Wilkinson, MD

vii

Contents

PART I Principles

1 History of Surgery for Retinal Detachment 3

2 Pathogenesis, Epidemiology, and Natural Course of Retinal

Detachment 9

Role of the Vitreous in Pathogenesis of Rhegmatogenous

Retinal Detachment 10

Vitreous Liquefaction 10

Myopia 11

ix

xContents

Trauma 11

Inflammation 12

Vitreous Detachment 12

Vitreoretinal Traction 14

Liquid Currents 15

Postnecrotic holes 20

Retinal breaks due to proliferative diabetic retinopathy 21 Macular holes 22

Epidemiology of Retinal Detachment 30

Variables Regarding Epidemiology 31

Race 31

Heredity 31

Bilaterality 31

Systemic and Genetic Conditions Associated with Retinal Detachment 32

Classification of Retinal Detachments 32 Pathology of the Detached Retina 33

Proliferative Vitreoretinopathy 33 Intraretinal Macrocysts 35 Demarcation Lines 36

Natural History of Untreated Detachment 36

Summary 37

Stereopsis and depth of focus 45

xii Contents

Reoperation 94

Contents xiii

Chronic persistent subretinal fluid 94

Summary 94

Symptomatic horseshoe-shaped tears 131

Contents xv

Summary 180

8 Pneumatic Retinopexy 181

Intraocular Gases 181

Choice of Gases 181

What size gas bubble is needed? 183

Contents xvii

Closure of sclerotomies and peritomies 212

Vitrectomy Techniques for Complicated Cases 212 Retinal Detachment and Proliferative Diabetic Retinopathy 212

Vitrectomy for PDR and retinal detachment 214 Removal of fibrovascular PDR tissue 215 Treating retinal breaks in PDR 217

Retinal Detachment and Proliferative Vitreoretinopathy 217

Scleral buckle for PVR 219 Removal of vitreous 219

Removal of epiretinal PVR membranes 219 Retinotomy and retinectomy in PVR 221 Marking retinal breaks 222

Internal drainage of fluid and vitreous replacement 222

Giant Retinal Tear 223

Results of Vitrectomy 226

Complications of Vitrectomy 226

Summary 227

10 Selection of Surgery for “Routine” Retinal Detachment 229

Surgery for Common Types of Retinal Detachment 230 Scleral Buckling 231

Advantages of scleral buckling 232 Disadvantages of scleral buckling 232

Pneumatic Retinopexy 232