Retinal dialysis.

Retinal dialysis is an important cause of retinal detachment and subsequent reduction of vision in the younger age groups. Dufour (I969) found that up to the age of 20 years such cases form 8 to I o per cent. of all cases of retinal detachment. Leffertstra (I 950) and Hagler and North (1968) have analysed groups of patients with dialysis and have described the clinical features of detachments caused by this type of retinal hole. In the surgical treatment of detachment due to dialysis, the value of encirclement procedures combined with drainage of subretinal fluid has been stressed by Hagler and North (i968), Hudson (i965), and Cox, Schepens, and Freeman (I966). Blach and Davies (I967) suggested that, for most dialyses, a local procedure may be used, but for giant dialyses an encircling procedure was advised. Lincoff and Kreissig (I972) and Scott (I970) have advocated the avoidance of drainage of subretinal fluid in the treatment of retinal detachments, as this removes many of the serious complications (e.g. choroidal haemorrhage) of retinal surgery. Nadel, Gieser, and Lincoff (I 97 ) successfully treated seventeen cases of retinal detachment due to dialysis with external plombage and cryotherapy without drainage of subretinal fluid. Lccal procedures are advantageous because they largely avoid the various degrees of anterior segment ischaemia described by Crock (I967) that may be expected after encirclement procedures. The purpose of the present paper is to report the results of treatment of 62 consecutive cases of retinal dialysis. In order to investigate the efficacy of the procedure, a prospective series of twenty cases was treated with local plombage without drainage of subretinal fluid, and the results were compared with those in 44 cases treated with drainage of subretinal fluid. Various aspects of the surgical technique of external plombage and cryotherapy as used in these operations are described.