No abstract

Many modern series showing the results of the treatment of retinal detachment report high success rates (Custodis, I965; Davis, I965; Jesberg, I965; Hagler, I965; Schepens, i965; Kreiger, Hodgkinson, Frederick, and Smith, 1971). The object of this report is to focus attention on anatomical failure in retinal detachment surgery in an attempt to highlight the important preoperative, operative, and postoperative factors that can contribute to failure, and as a result ofthese findings to suggest means by which the incidence of failure may be reduced.In this series failure has been defined as either incomplete flattening of the retina after surgery, or re-detachment within a period of 6 months. Material and methodsIn this series only cases which have been treated exclusively by the unit have been included. This is because it was sometimes difficult to be sure of the factors responsible for failure in cases that had been operated upon elsewhere as it was not possible in such cases to observe either the preoperative state or the operation itself. Those which received prophylaxis only have not been included.There were 452 cases treated by the Unit between I967 and I972. The minimum follow-up period was 6 months. Cases were operated upon by either a Resident or a post-graduate Surgeon.Although there was sometimes divergence of views amongst us about the surgical treatment of some cases, in general the techniques employed were similar. Thus, for local procedures, episcleral silastic sponge implants buckled over full-thickness sclera were used, and for encirclement procedures, episcleral silicone rubber bands. In all cases cryotherapy was employed.The data on the failed cases in this study were compared to those obtained from a study of 0OO randomly selected successful cases ranging over the same period of time. ResultsOf the 452 cases, I I4 (25 per cent.) needed further surgery after the first operation. It was possible to re-attach 6I of these (a further 13 per cent.), but 53 cases (12 per cent.) were complete failures. Thus the overall success rate in this series was 88 per cent. (Table I). Of the I I4 cases, five were successfully re-attached after the first operation but re-detached within 6 months. PREOPERATIVE FACTORSThe factors that were found to be of particular significance (P < o .os) are set out in Table II. The term "uncertain holes" refers to cases in which it was not possible to be sure of the exact location of some or all of the retinal holes. The depth of subretinal fluid was roughly estimated by clinical examination as the depth of the subretinal fluid beneath the

No abstract

Glaucoma is a rare complication of retinal detachment surgery. Smith (I967) reported postoperative angle closure in 4 per cent. of I,ooo consecutive scleral buckling procedures. He believed the mechanism to be a forward rotation of the ciliary body with shallowing of the anterior chamber and angle closure. Fiore and Newton (I970) investigated 34 patients after scleral buckling with encirclement and found that four were shallow after 2 months; the remainder became shallow temporarily but had returned to preoperative levels in 2 months. One of these had a choroidal detachment which recovered. We have set out to pursue these findings further: firstly, to compare anterior depth changes after various types of detachment surgery, and secondly, to investigate the early postoperative period. MethodsPatients suffering from untreated retinal detachments presenting at Moorfields Eye Hospital and the Western Ophthalmic Hospital over a period of 9 months were included in the survey. The patients were assessed preoperatively as follows: a history was recorded with emphasis on any previous family incidence of glaucoma. Visual acuities and refractive errors were noted. Applanation values, with pupils dilated, were taken. Gonioscopy was performed, recording the angles as deep, medium, or shallow (a short note was added on the trabecular appearance). The anterior chamber depths were measured with the Haag-Streit Type 2 Pachometer (Lowe, I966) when the pupils were dilated. The corneal thickness was measured and then the distance from the anterior corneal surface to the anterior lens capsule. The instrument provides a reliable comparative reading without further correction. Operative procedures were documented to include the use of osmotic agents, the type and size of plomb or encircling strap, its average distance from the limbus, any muscles detached, any drainage of subretinal fluid, the number of quadrants treated with cryotherapy, and operative complications, such as vitreous or choroidal haemorrhages, paracentesis, and, lastly, in some cases, applanation on completion.Postoperative readings were made of anterior chamber depth and applanation. Gonioscopy was carried out if any marked shallowing occurred. These readings were taken on the first postoperative day, if possible, and at least twice in the first week. Readings were continued weekly until the preoperative depth was regained or for a follow-up period of at least 3 months in all other cases. ResultsA total of 56 patients was examined and they were divided into four main groups (Table I).The amount of shallowing of the anterior chamber, the time that this occurred, and any special comments are set out in Tables II to V.