[Surgical treatment of progressive and symptomatic retinal detachment in senile retinoschisis].

Abstract

Background: This is 23-years retrospective study of consecutive, non-selected patients with senile retinoschisis and rare progressive and symptomatic retinal detachment (RD). The presence of RD was manifested by spectrum of retinal pathology of inner and outer layers of senile retinoschisis, ranging from simple holes to giant tears with or without proliferative vitreoretinopathy. The goals of this study were: 1--to evaluate the characteristics of the progressive and symptomatic RD based on detail preoperative examination of the eye, 2--to evaluate the anatomic and functional results of RD surgery.

Patients and methods: From 1978 to 1999, RD surgery was performed on 57 eyes of 55 patients (28 men and 27 women) with senile retinoschisis and progressive and symptomatic RD. On average, we observed the patients for approximately 11.3 years after surgery; the minimum follow-up period was 20 months. The patients were divided in two groups according to the preoperative findings and the surgical procedures. Based on the size and the location of the defects of the inner and outer layer of senile retinoschisis and the proliferative vitreoretinopathy these procedures were indicated: 1--Uncomplicated cases of progressive and symptomatic retinal detachment were operated on primary cryopexy and scleral buckling (CSB) with episcleral silicone implants in 45 eyes. 2--Complicated cases of progressive and symptomatic retinal detachment underwent a pars plana vitrectomy (PPV) in 12 eyes: a--primary PPV was used as the primary treatment method in 6 eyes, b--secondary PPV as a secondary treatment method after unsuccessfully primary CSB with episcleral silicone implants in next 6 eyes.

Results: Characteristics preoperative findings were: RD in two or more quadrants in 84.2% of the eyes, including macula region in 71.9% of the eyes. Defect of the outer layer of senile retinoschisis was located postequatorial in 80% of the eyes, large retinal tears were found in 53.3% of the eyes and single defect was diagnosed in 68.8% of the eyes. Defect the of inner layer of senile retinoschisis was located equatorial in 69.5% of the eyes, small defects were found in 78.2% of the eyes and multiple defects were diagnosed in 58.6% of the eyes. Defects of the outer and the inner layer of senile retinoschisis were diagnosed in the equal quadrant in 61.4% of the eyes. The results of surgery varied, depending on the size and location of the defects of the inner and outer layer of senile retinoschisis and proliferative vitreoretinopathy: 1--The complete retinal reattachment in group treated with CSB was achieved in 43 eyes (95.5%), the average visual acuity was 0.34-2--The complete retinal reattachment in group treated with PPV was achieved by: a--primary PPV in six eyes, the average visual acuity was 0.37, b--secondary PPV four eyes, the average visual acuity was 0.16.

Conclusions: Characteristic of senile retinoschisis, especially its defects of inner and outer layers is important preoperative finding for optimal indication of primary surgical treatment of progressive and symptomatic retinal detachment. According to our clinical experiences we created the syllabus of the care about the senile retinoschisis and syllabus of surgical treatment of progressive and symptomatic RD. Standard surgical procedures are the CSB and in the last period also primary PPV.