Retinaldetachment奥比斯专家视网膜脱离.ppt

Indications for cryo buckle No PVD Dialysis Atrophic round holes Avoid cataract formation Avoid temporary loss of vision Cryo buckle Drain Benefits Soften eye – larger indent Allow apposition of RPE retina Allow internal tamponade Risks Haemorrhage Incarceration Internal tamponade Air – 5 days Single break, superior SF6 – 20-25% - 14 days 1 or 2 quadrants C3F8 – 12-14% - 40 days 2 quadrants Silicone oil – permanent PVR or high risk of PVR Reasons for failure PVR New / missed breaks Inadequate retinopexy Inadequate tamponade / buckle PVR Definition Risk factors Blood Inflammation Cataract surgery Trauma Prophylaxis Heparin 5-FU in high risk cases only Complications of RD PVR Epiretinal membrane Hypotony Uveitis Cataract Complications of RD surgery External Diplopia Extrusion Infection Haemorrhage incarceration Internal Cataract Glaucoma Haemorrhage PVR Infection Outcomes Anatomical 80-90% anatomical success with one operation 70-80% anatomical success with second op 95% final success with 2+ operations Functional VA improves for 6/12 post-op Main determinants are pre-op VA separation of macula from RPE Consent for RD surgery Risk of failure / second operation Final vision Mac on or Mac off Cataract if vitrectomy Gas Flying, G/A, vision posturing Diplopia if scleral buckle Summary Retinal detachment is caused by break +/- PVD Prophylaxis valuable for U-tears Treat by closing break and permanent adhesion Outcomes of surgery are good, but mac-off never recovers fully This picture shows a: Star turn Star fold Star sign Star Trek It signifies: The winner of Pop Idol PVR Imminent meeting with tall dark stranger Impending Klingon attack Pin the tail on the monkey A B C Retinal detachment Types of RD Rhegmatogenous Traction Exudative Types of RRD Horseshoe tear Atrophic hole Dialysis Giant tear HST PVD Starts with PVD Traction relieved by operculum Persistent vitreous traction Increasing sub-retinal fluid Rapidly progressive Atrophic hole Myopic Young No PVD Ofte