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Fashioned retinotomy for management of recurrent lower retinal detachment with inferior proliferative vitreo-retinopathy

Session Details

Session Title: Vitreoretinal Surgery II

Session Date/Time: Friday 12/09/2014 | 14:30-16:00

Paper Time: 15:26

Venue: Boulevard C

First Author: : M.Elmalt EGYPT

Co Author(s): :                  

Abstract Details


allowing the inferior retina to conform to the underlying retinal pigment epithelium/choriod in cases where there is persistent inferior traction despite complete membrane peeling;due to subretinal or intrinsic retinal contraction.In these cases the retina does not settle down even if an inferior scleral buckle or heavy silicone is used;thus causing a residual inferior shallow retinal detachment that usually reaches the macular area within 2-3 months after primary surgery


The research institute of ophthalmology (RIO) in CAIRO-EGYPT


15 patients with inferior proliferative vitreo-retinopathy causing recurrent shallow retinal detachment under silicone were enrolled in this work .inclusion criteria included: -inferior shallow retinal detachment under silicone and involving the macula partially or totally. -duratin of re-detachment not exeeding 3 months in all patients -all patients underwent primary vitrectomy by the same surgeon using silicone oil - phakic and none cataractous exclusion criteria: -silicone under filling -early emulsification -diabetics -aphakic and pseudophakic patients all patints underwent surgery with local anaesthesia;silicone oil was removed;perfluorocarbon liquid was used to stabilize the inferior retina and remove all new and residual membranes off the inferior retinal surface.A circumferential retinotomy was done in the far periphery enclosing the sector of the inferior retina that was involved in the proliferation .2 short radial cuts were done at each end of the circumferential retinotomy .The anterior radial cuts were extended to the ora and the created retinal flap was removed.The posterior radial cuts were made as short as possible and only extended posteriorly if this allows better conformation of the retina onto the underlying retinal pigment epithelium while on air.Silicone oil was reinjected and extensive laser was done to the edges of the created retinotomy


we succeeded in achieving permenant retinal re-attachment in 14 cases after 6 months-1 year follow up with a success rate of 93.3% regardless the cause of the primary retinal detachment. visual acuity of all patients varied according to various factors including;the primary condition of the patient before his primary surgery;the duration between the onset of retinal detachment and time of surgery;extent and duration of macular involvment;the duration between the primary and secondary surgical intervention ;and the presence of any grade of lens opacity after the second intervention. silicone was retained for 6 months in all eyes. After 6 months silicone was removed together with small incision phaco emusification and foldable intra ocular lens implantation in all eyes.None of our patients needed filtering surgery for increased intra ocular pressure;medical treatment was rather sufficient


although several modalities are used to tackle the problem of inferior proliferative vitreo-retinopathy including anti-proliferative drugs ,heavy silicone oil,inferior scleral buckles,strict patient positioning....etc,yet none of these methods presented final solutions for the serious ever-endangering and threatening condition of recurrent inferior proliferative vitreo-retinopathy.In this work we are adressing this problem in a different way by freeying the inferior sector of the retina from its continuation with retinal periphery curcumferentialy and radialy thus creating an anterior and a posterior retinal flap. the anterior flap is removed while the posterior one (the free flap) is anchored to the underlying retina by laser after being free to retract a little bit posteriorly .this new position allows the retinal flap to conform easily onto the underlying retinal pigment epithelium ;thus enabeling laser to create strong adhesions thus preventing further retraction of the flap

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