Trends in der Ablatiochirurgie

C. V. Fischer, M. Kulanga, H. Hoerauf

In 2001 a survey among retinal surgeons regarding the treatment of rhegmatogenous retinal detachment either with scleral buckling methods or primary vitrectomy was performed. Due to the technical progress of vitrectomy and observational systems, it seemed appropriate to renew and update this survey supplemented with current aspects. In this study 78 vitreoretinal surgeons from German-speaking countries were surveyed via an anonymous online questionnaire on their treatment decisions for defined retinal detachment constellations. Furthermore, general aspects, such as surgical experience, timing of surgery and anesthesia were queried. The results were compared to the results of 2001. Only 31.1% of the surgeons had performed more than 1000 scleral buckling procedures, whereas 80.8% had performed more than 1000 primary vitrectomies, 72.7% use mainly 23 gauge, 19.5% use 20 gauge and 7.8% use 25 gauge vitrectomy systems. Of the participants 88.5% perform retinal detachment surgery also on weekends and 85.9% in emergency services. In cases of one-hole configuration 73.1% of surgeons would choose treatment with a scleral buckle and only 7.7% with primary vitrectomy. The willingness to perform scleral buckling procedure decreases with coexisting risk factors. In the presence of two adjacent retinal tears but still treatable by scleral buckling, only 56.9% would perform a conventional buckling technique but 33.3% primary vitrectomy. In a more complex retinal hole configuration but still treatable with scleral buckling elements, only 6.4% would chose scleral buckling whereas 71.8% primary vitrectomy. In comparison with the 2001 survey, there is a marked trend in retinal detachment surgery in favor of primary vitrectomy not only in pseudophakic eyes. General anesthesia was the preferred anesthesia method and in a macular-on situation nearly 50% of the responders would perform surgery on the next day. The results of our survey confirm an obvious tendency away from buckling surgery towards primary vitrectomy in the treatment of rhegmatogenous retinal detachment.