Recurrent Retinal Detachment
17
Ulrich Spandau and Zoran Tomic
17.1 Introduction
The main question when examining the retina of
a recurrent detachment is: Where is the hole? If a
new hole is present, we would operate the eye as
a primary detachment. But in many cases, a reti-
nal break cannot be found. In this case a minihole
must be searched for. This minihole is often a
laser necrosis and located at the edge of a laser
scars. In order to localize the hole, you must
remember the Lincoff rules and use the following
trick: Inject PFCL posterior to the suspected hole
and look for Schlieren. Schlieren is subretinal
fluid which enters the vitreous cavity through the
hole. Search for the hole using a light fiber and
scleral depressor.
If you found the hole, then perform a laser
photocoagulation. If you are insecure about the
hole location, then place a buckle according to
the Lincoff rules.
But if an already laser-treated hole reopened, I
would place a segmental buckle on this hole.
Why? Well, why did this hole reopen although
the hole edges were laser photocoagulated?
Traction on the edges? Pigment epithelium atro-
phy? So, something is wrong with the hole and
the regular tamponade with gas did not do the
job. If obviously a gas tamponade could not seal
U. Spandau (*) · Z. Tomic
Department of Ophthalmology,
Uppsala University Hospital, Uppsala, Sweden
© Springer International Publishing AG, part of Springer Nature 2018
U. Spandau et al. (eds.), Retinal Detachment Surgery and Proliferative Vitreoretinopathy,
https://doi.org/10.1007/978-3-319-78446-5_17
the hole, then a stronger sealing is necessary. An
episcleral buckle is a more effective sealing
method. Alternatively, place two to three rows of
laser around the old laser scars and finalize sur-
gery with a tamponade.
If you cannot find the hole, then I would again
place a segmental buckle according to the Lincoff
rules or alternatively instill a permanent silicone
oil tamponade.
17.2 Surgical Technique
for Recurrent Detachment
Under Silicone
There are two surgical options: (1) Leave the
silicone oil and remove the epiretinal mem-
branes under silicone oil. This so-called inter-
face vitrectomy is only advisable for experienced
surgeons (see chapter of Dr Ghasemi from Iran).
(2) Remove the silicone oil and inspect the ret-
ina under BSS. The advantage of this procedure
is that the complete retina can be assessed under
BSS, and you may detect membrane and holes
which were covered under the silicone oil.
17.3 Conclusion
In case of a recurrent detachment under silicone
oil, we recommend first the complete removal of
silicone oil. Then stain the retina for membranes,
163
164 U. Spandau and Z. Tomic

continue with the consequent removal of mem- with laser and silicone oil tamponade. The author
branes, and finalize with a silicone oil tamponade. Ulrich Spandau prefers a combined vitrectomy
with laser and episcleral buckling.

17.4 Surgical Management

of a Recurrent Detachment 17.4.2 Examples

17.4.1 Two Surgical Procedures Total recurrent detachment (Figs. 17.1 and 17.2).

When a recurrent retinal detachment occurs, the

authors prefer two different surgical approaches:
The author Zoran Tomic prefers a vitrectomy

a b
Old
buckle

1000 csts
silicone oil

Fig. 17.1  Initially a chronic PVR C2 detachment. o’clock (a). The silicone oil was removed, the break
Operated with combined buckle/vitrectomy and laser treated, and a Densiron 68 tamponade used. After
1000  cSt silicone oil. Two weeks later an inferior 2  months the silicone oil was removed and the retina
detachment occurred with a small retinal break at 6 remained attached (b)
17  Recurrent Retinal Detachment 165

a b

Fig. 17.2  Initially a total detachment with PVR B2 and a inferior redetachment occured. A circumferential segmen-
retinal break at 12 o’clock (a). A vitrectomy with silicone tal buckle was placed from 5:30 to 6:30. The retina reat-
oil was performed. One week after silicone oil removal an tached (b)