[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?


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.


METHODS
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%).


CONCLUSIONS
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.
Kreissig
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I
Universitäts-Augenklinik Tübingen, Abteilung Augenheilkunde III.
Rose
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D
Kuck
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H
Dimitrakos
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011677:Punctures; D012008:Recurrence; D012086:Reoperation; D012163:Retinal Detachment / Q000601:surgery*; D012167:Retinal Perforations / Q000601:surgery; D012591:Scleral Buckling
Lochbegrenzte Ablatio-Chirurgie ohne Punktion: Langzeit-Ergebnisse zur Frage der postoperativen "Restablatio" und späten Reablatio.