Advances in The Treatment of Rhegmatogenous Retinal Detachment
Advances in The Treatment of Rhegmatogenous Retinal Detachment
Advances in The Treatment of Rhegmatogenous Retinal Detachment
·Review Article·
bulbar conjunctiva at the edge of the sclera, which can affect macular edema, are related to overly extensive and excessive
the microenvironment of the ocular surface, cause damage condensation. The key is to master the proper amount of
to the goblet cells and tear ducts, and reduce the production condensation needed, which can be achieved by direct operation.
of mucin and basic tear secretion[7-8]. The patient may then Scleral Electrocoagulation Scleral electrocoagulation
have an acidic burning sensation, swelling, discomfort, dry involves the application of high electric heat, or diathermy, to
eye, or eye-winking sensation after the operation. Wong et critical areas of the sclera, thereby resulting in an inflammatory
al[9] performed scleral ring ligation on 30 patients with RRD reaction, scar adhesion and closure of the retinal hiatus. The
and concluded that the treatment can indeed affect the ocular adhesion is relatively firm and has a highly reliable, curative
surface microenvironment, thereby resulting in decreased tear effect. However, if this method is performed in an area
secretion, shortened tear break-up time (BUT), and increased that cannot be directly seen by the surgeon, it may result in
positive rates of corneal fluorescein (FL) staining, all of which damage to the sclera and choroid vitreous body. Excessive
take time from which to recover. Therefore, the scope of electrocoagulation is more likely to produce extensive scleral
surgery and the degree of injury should be minimized during necrosis, scleral expansion and staphyloma, which increases
operation to avoid unnecessary complications. the difficulty of reoperation. Therefore, at present, scleral
Episcleral compression In episcleral compression, the condensation has displaced electrocoagulation and has been
general scleral location of a hole is marked, and then the widely used[16].
sclera is pressed towards the center of the eye with a pressure Retinal Laser Photocoagulation The use of lasers is an
device to determine the exact location of the hole on the important method for treating and preventing retinal detachment,
scleral surface. The ridge caused by the pressure is positioned mainly for treating peripheral retinal degeneration and closed
at the posterior margin of the hiatus, and a mattress suture retinal hiatuses, preventing retinal detachment in denatured
is used to fix the ridge in place, which effectively seals the areas and promoting retinal restoration. The light energy of a
hole. The purpose of developing external surgery for RRD is laser is absorbed by the hemoglobin or uveal pigment in the
to seal the hiatus with minimal surgical invasion, to improve retina and vascular tissues and transformed into heat energy,
repositioning rates and to reduce surgical complications[3]. resulting in tissue degeneration and coagulation. At the same
This simple external compression surgery was pioneered by time, the RPE in the area of photocoagulation is temporarily
Lincoff and Kreissig[10] and yielded good clinical results for damaged, and the passive motion of the subretinal fluids is
the treatment of RRD using segmented scleral compression accelerated, causing a decrease in uveal effusion and increased
without drainage; the treatment reduced complications such retinal adhesion, which finally close the hiatus. Research
as refractive changes, anterior ischemia, suprachoroidal has demonstrated that laser photocoagulation has the same
hemorrhage, and visual field reduction[6,11-13]. Clinical practice anatomical reduction rate as does condensation, but the extent
has shown that minimally invasive retinal surgery, including of retinal damage is lower and complications are fewer[17-18].
vitreous condensation, which does not impact discharge, optic Intraoperative denaturing of certain areas in the retina and the
circulation, scleral injection, or scleral extravasation, has the protruding edges of the hiatus can be accomplished by a laser,
merits of accurate positioning, reliability in minimal surgical unlike the extensive ligation and condensation procedures
trauma and avoidance of certain complications from traditional previously used to prevent detachment in other sites. The
scleral surgery while maintaining a high success rate. lasers used are mainly the 532 semiconductor fundus laser
Therefore, the approach is a good alternative surgical method (BVI, French), the argon laser (ZEISS, Germany) and the
for the treatment of RRD[14-15]. multiwavelength krypton laser (Qioptiq, England). Li[19]
Scleral Condensation Scleral condensation, which has the studied 89 patients with retinal holes treated by surrounding
advantages of simplicity, minimal scleral damage, external the holes with spots of photocoagulation using a 532 nm
compression and a definite curative effect, is the most commonly frequency-doubled laser. The results of the study showed
used external operation for sealing the retinal hiatus in retinal that after 6-30mo, 97 of the treated eyes (99%) were sealed,
detachment. Condensation is a safe and effective sealing and the subretinal fluid was absorbed completely after
method. However, scleral condensation can lead to cell laser photocoagulation. This finding demonstrates that
death and aseptic necrosis of tissues, which can cause local photocoagulation with a 532 nm frequency-doubled laser is
inflammatory reactions in the choroid and retina, ultimately a convenient method for treating retinal holes with less tissue
resulting in the adhesion of the RNL to the RPE and the damage and great therapeutic effect. Li[20] also researched
formation of scar tissue that seals the retinal hiatus. Many seventy-two cases (78 eyes) of retinal holes treated with a 532 nm
complications, such as iatrogenic retinal tear, choroidal frequency-doubled laser to show that photocoagulation with
ischemia, proliferative vitreous retinopathy (PVR), and this laser is effective and safe. Gao et al[21] retrospectively
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BCVA: Best corrected visual acuity; SB: Scleral buckling; PPV: Pars plana vitrectomy.
tends to be self-limiting and self-healing. Currently, more 11 Wu TE, Rosenbaum AL, Demer JL. Severe strabismus after scleral
observations are needed. The fundus of a patient after self- buckling: multiple mechanisms revealed by high-resolution magnetic
To summarize, at present, RRD is still one of the most common 12 Kreissig I. Treatment of primary retinal detachment. Minimal
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Advances in RRD
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