How can physicians minimize the problems that may occur during retinal detachment surgery? Steven T. Charles, MD, shared lessons drawn from his experience, during Retina Subspecialty Day on Friday.
There are both surgical and biological causes for failure. The most common failures are untreated breaks and residual tractions. Dr. Charles emphasized that it is “absolutely critical” to do everything to treat every possible break.
Visualization is key. “Poor visualization, is one of the main causes of errors in identifying tears,” explained Dr. Charles. The failure to fully visualize can lead to both untreated retinal breaks and residual traction. Wide-angle visualization and scleral depression are, therefore, crucial in assessing the peripheral retina and identifying traction and tear, he said.
Conceptualization helpful. “The term that I really like is conceptualization,” said Dr. Charles. Although it sounds simple, conceptualization can help to locate the initial retinal detachment or break. Evaluating a patient’s “shadow” history, the highest point of detachment, concentric demarcation lines, and localized pigmentation can help locate breaks. He also emphasized using conceptualization as a diagnostic tool, “not just a step in surgery.”
To visualize residual vitreous traction, Dr. Charles recommended performing vitrectomy under air. Localized and marked elevation of the equatorial retina is usually a good indicator.
Scleral buckles, 360° laser are not the answer. Dr. Charles does not combine scleral buckles with pars plana vitrectomy for a number of reasons, lack of randomized clinical trial evidence showing that it increases success rates. Further, he wants to avoid complications of buckling. Rows of 360° laser can also lead to complications, such as increased inflammation and possibly increased proliferative vitreoretinopathy.
Dr. Charles encouraged the audience to go back to basics. “Think through how you are going to do your visualization and conceptualization so you get these things fixed on the first go."—Kanaga Rajan
Financial disclosures. Alcon Laboratories, Inc.: C,P.
Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.
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