Pharmacological approaches to improve surgical outcomes after retinal reattachment surgery

Abstract

Prior to the modern era ushered in by Gonin,with the recognition that retinal detachment is caused by retinal breaks, a variety of nonspecific and pharmacological methods were employed, without predictable success, for the treatment of retinal detachment. It remains true today that the most important pharmacological agent in the diagnosis and treatment of retinal detachment is the mydriatic drop, since without adequate visualization of the fundus and identification of the break, no definitive treatment is possible. Other opportunities still exist for the pharmacological enhancement of retinal reattachment, by improvement in both anatomical and functional results. These include (1) improvement in the final retinal reattachment rate, (2) improvement in visual acuity following successful retinal reattachment, and (3) reduction in complications. Inasmuch as the majority of routine or uncomplicated retinal detachments can now be accomplished safely by utilizing modern scleral buckling techniques, the risk-benefit ratio of utilizing potentially toxic pharmacological agents under routine circumstances has to be carefully considered in light of the opportunities for marginal potential improvement [1]. However, given the increasing utilization of pneumatic retinopexy, which seems to have a lower initial retinal reattachment rate than conventional scleral buckling [2], the justification for the use of pharmacological agents may be increased. Some authors now propose primary vitrectomy without scleral buckling as a first operation, and although the immediate postoperative morbidity may be lower, the final rate of proliferative vitreoretinopathy (PVR) may be higher than scleral buckling alone [3-5]. Similarly, when scleral buckling alone is considered for eyes with early or late forms of proliferative vitreoretinopathy, success rates are considerably lower, and the case for use of an adjuvant agent, either to facilitate intraoperative flattening, such as perfluorocarbon, or one of several different anti-proliferative agents seems better justified [7-9].Recently, a British group has developed a predictive formula to calculate the risk of PVR following primary retinal reattachment, which may aid in the selection of patients who might benefit most from the use of adjuvant pharmacological methods [10]. © Springer-Verlag Berlin Heidelberg 2005.