Surgical therapy of tear-induced retinal detachment – a clinical and historical view

Purpose:

The aim of this clinical article is to describe the surgical treatment of tear-related retinal detachment in the context of the individual retinal findings, the lens status and in consideration of the surgical and postoperative risks, taking into account the specific situation of each patient.

Material and Methods:

Rhegmatogenous retinal detachment is the result of a retinal tear caused by traction of the vitreous on the retina. Liquefied vitreous enters the subretinal space and separates the sensory retina from the pigment epithelium-Bruch’s - membrane complex. As a result, the retina loses contact with the choroid supplying the outer retinal cell layers. The damage caused by the reduced supply, especially to the foveal retina, determines the urgency of surgical treatment.

Two very different surgical procedures are available for therapy: buckling surgery and pars plana vitrectomy. Both surgical methods have different indications and risks and are explained on the basis of our own clinical experience, together with other publications on the same subject, also in their historical context.

Results:

The treatment goal of rhegmatogenous retinal detachment is to bring the retina closer to the retinal pigment epithelium, which ‘pumps out’ the fluid from the subretinal space, and reestablishing the retinas contact to the choroidal supply. The entry of fluid into the subretinal space must be permanently prevented by induced scarring. Whether a buckling surgery or a pars plana vitrectomy is indicated depends on the respective retinal findings. The greatest risk after any surgery for a tear-induced retinal detachment is the development of a proliferative vitreoretinopathy and a resulting renewed retinal detachment.

Conclusion:

Early detection of retinal detachment by the symptoms flashes, floaters, shadows and early binocular ophthalmoscopy is important to prevent progression of retinal detachment into the fovea and to organize vitreoretinal surgery as soon as possible. The visual prognosis of retinal detachments with foveal or macular involvement has improved significantly in the last decades.