Program list

SYMPOSIUM: STRATEGIES
SECTION: To prevent complicated stages of PVR
Moderators: William Mieler, Francesco Boscia
Tuesday, September 16th, 2003 ; 8:20 - 9:50

SURGICAL STRATEGY BASED ON CLINICAL FINDINGS IN STAGE O, A AND B
Didier Ducournau, MD
Nantes, France

Systematic vitrectomy is becoming more and more popular to treat retinal detachments even if there are not severe. In fact, it resolves many problems, does not necessitate a high understanding of RD etiopathology, nor precise pre-op examination and allows a permanent control of the procedure through the microscope. However, vitrectomy carries with itself a certain numbers of complications (cataract, vitreo retinal incarceration, iatrogenic tears, PVR, endophtalmitis…) justifying that one must weight up the pros and cons regarding his own capacities and insufficiencies. This is why, I proposed the following strategies:
- retinopexy-gas in some retinogenous RDs with hole/dialysis in the 300 superior degrees, some vitreogenous with low evolution and small tears without active/dynamic or static vitreous tractions.
- buckling in all the other cases, if vitrectomy is not carries out.
- vitrectomy on the following indications:
" Indication independent of PVR stage:
1. optical opacities
2. dislocated lens
3. associated macular pathology
4. perforation
5. tractionnal RDs
6. operating complications
" Indication according to PVR stages
1. stage 0: posterior hyaloid pathology
" RD with idiopathic MH in high myopia
" RD with idiopathic posterior hyaloid fibrosis
" some RD with optic pits
2. stage A: when indentation is insufficient or too dangerous
" giant tear
" posterior pole tear
" scleromalacia
" retrobasal tears on different anterior posterior location
" space problem
" associating numerous clinical details
3. stage B
" large retrobasal tear
" beginning of macular retraction