[Primary vitrectomy with peeling of the internal limiting membrane under decaline: a promising surgical maneuver for treatment of total and subtotal retinal detachment]

Abstract

Objective of surgery: The aim of the surgical treatment of retinal detachment is retinal reattachment especially of the central portion for the best possible regeneration of functional visual outcome.

Indications: Total and subtotal retinal detachments in combination with macular involvement were investigated.

Surgical technique: After complete 20 or 23-gauge pars plana vitrectomy (ppV) the internal limiting membrane (ILM) was stained with Brilliant Blue for 30 s. The detached and more mobile central retina was weighted and stabilized with decaline so that the raised ILM could be carefully peeled away under the decaline level. Removal of residual decaline was followed by drainage of subretinal fluids through the retinal foramen and fluid-air exchange. To prevent renewed detachment circular laser coagulation was performed under air and followed by tamponade with silicone oil or SF6 gas depending on the status of the retina.

Results: The surgical intervention could be successfully performed in all selected patients with a primary reattachment rate of 100 %. In the 12-month follow-up period no renewed detachment or formation of a secondary epiretinal membrane was observed. The postoperative visual acuity (VA) showed a statistically significant increase (p < 0.0001) in the Wilcoxon test for paired samples.

Conclusion: Primary vitrectomy with ILM peeling under decaline is a promising but ambitious surgical intervention for the treatment of incomplete and complete retinal detachment with and without proliferative vitreoretinopathy.