V.B.6. Retinectomy for Recalcitrant Retinal Detachments

Abstract

Anterior proliferative vitreoretinopathy (PVR) is the greatest challenge facing the surgeon attempting to repair recurrent retinal detachment [1]. The Retina Society recognized this and, to create a more prognostic classification, added anterior proliferation and posterior proliferation (extensive macular pucker) to its ABCD classification of PVR [2] (Figure V.B.6-1). The traction forces at the vitreous base were classified as circumferential or anterior (Figure V.B.6-2), acknowledging the complexity of contraction of fibrous tissue formation in this zone. Machemer first described retinotomy in 1981 [3] for incarcerated retina in a ruptured globe. Zivonovich described its application for severe traction membranes [4]. Subsequent reports followed [5–9] and emphasized the importance of removing retina anterior to the retinotomy to prevent re-proliferation, extending the retinotomy to an adequate size, the importance of long-term tamponade, and the benefit of perfluorocarbon liquids. In the PVR Silicone Oil Study, retinotomy was performed in 29 % of cases [10].