Rhegmatogenous retinal detachment and conventional surgical treatment.

AIM The aim of the paper was to present the efficacy and indications for application of conventional surgical treatment of retinal detachment by using external implants, that is,application of encircling band and buckle. MATERIAL AND METHOD This study comprised patients from the University Eye Clinic in Skopje. A total of 33 patients were diagnosed and surgically treated in the period between May 2010 and August 2011. Conventional surgery was applied in smaller number of patients whose changes of the vitreous body were manifested by detachment of posterior hyaloid membrane, syneresis, with appearance of a small number of pigment cells in the vitreous body and synchysis, and the very retina was with fresh detachment without folds or epiretinal changes (that is, PVR A grade). There were a larger number of patients with more distinct proliferative changes of the vitreous body and of the retina, grades PVR B to C1-C2, and who also underwent the same surgical approach. Routine ophthalmologic examinations were performed, including: determination of visual acuity by Snellen's optotypes, determination of eye pressure with Schiotz's tonometer, examination of anterior segment on biomicroscopy, indirect biomicroscopy of posterior eye segment (vitreous body and retina) and examination on biomicroscopy with Goldmann prism, B scan echography of the eyes before and after surgical treatment. Conventional treatment was used by external application of buckle or application of buckle and encircling band. In case of one break, radial buckle was applied and in case of multiple breaks in one quadrant limbus parallel buckle was applied. Besides buckle, encircling band was applied in patients with total or subtotal retinal detachment with already present distinct changes in the vitreous body (PVR B or C1-C2) and degenerative changes in the vitreous body. Breaks were closed with cryopexy. RESULTS The results obtained have shown that male gender was predominant and that the disease was manifested in younger male adults. According to the present risk factor, high myopia was found in 5 patients, which has been emphasized to be a significant risk factor for onset of retinal detachment. Lattice degeneration was the most common peripheral degenerative change. The most frequently found was horseshoe retinal hole with vitreous traction and the break location was most common in the upper retinal quadrants. The most commonly applied type was limbus radial buckle with encircling band, depending on the pathological process in the eye. The retina was postoperatively attached in 31 eyes. In two cases, the retina was not attached; in one eye due to the inadequately inserted implant and in the other case due to the larger number of breaks (3) with more distinct PVR (C2), and postoperative inflammation and proliferative components were more intensified. In one patient who did not have a total detachment, but had a larger break placed posterior to the equator and PVR C1, redetachment appeared one month later due to a manifested fibroproliferative reaction, although the break was closed. Regarding visual acuity, the day following the surgery there was no improvement; moreover, there was a small decline of visual acuity due to exudates in the vitreous body and vitreous hemorrhage. After 3 months, there was a significant improvement in the largest number of eyes. Intraoperative complications included intravitreous hemorrhage, and postoperative more distinct proliferative component in the vitreous body was found in two patients. CONCLUSION Timely diagnosis and intervention in retinal detachment by application of an adequate method and less invasive technique gives excellent results in postoperative morbidity rate and rehabilitation of the vision. The results of the conventional treatment of retinal detachment justify its application in the treatment of this disease.