COMBINED EPI- AND AND VITREORETINAL SURGERY

Peter Strmen¢ (Bratislava)

The surgical management of the vitreoretinal diseases evolved in the last 50 years dramatically. The buckling procedures were introduced in the retinal detachment surgery in the 50's, expanding gases in late 60's. Machemer introduced pars plana vitrectomy in 1970. Silicone oil and haevy liqiuds extended further this armamentarium.

The results of the retinal detachment surgery in not very complicated cases are nearly the same with both approches (episcleral and vitreoretinal) till today. All complicated cases (giant tears, centrally located tears, breaks with marked tractions, hazy or haemorrhagic vitreous) are today treated by vitrectomy. The question is: have we combine vitrectomy with a buckling procedure in each complicated case, or only in cases where the possibility of PVR redetachment is very high?

Shall we use a preventive buckling procedure in all diabetic vitrectomies with centrally detached retina or in all cases with enophthalmitis?

The main goal of each vitreoretinal surgery is a clean vitreous cavity and attached retina with a special regard to the final visual function. Why to combine an episcleral with a vitreoretinal approach if the episcleral sponge or the circling band may cause further complications like refractive changes, diplopia, anisometropia, changes in the ocular blood flow etc.

There is a group of procedures, where nobody combines buckling procedure with vitrectomy, like in macular surgery (hole, pucker, edema, ARMD…), although the risk of PVR exists after each entering the vitreous cavity.

It should be discussed with participants when they perform combined episcleral and intravitreal surgery.


Back