Concept and application of relaxing radial retinectomy for retinal detachment with advanced proliferative vitreo-retinop
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International Journal of Retina and Vitreous Open Access
REVIEW
Concept and application of relaxing radial retinectomy for retinal detachment with advanced proliferative vitreo‑retinopathy Waldensius Girsang1,2, Dwi C. R. Sari3, Wahyu Srigutomo4, Tjahjono D. Gondhowiardjo1,5 and Muhammad B. Sasongko2*
Abstract Purpose: To revisit the concept of retinectomy and the theory of mechanical forces on the retina occurring in rhegmatogenous retinal detachment (RRD) and to describe the potential application of radial retinectomy in RRD with advanced proliferative vitreoretinopathy (PVR). Methods: A literature search was performed to identify all English language articles reporting the use of retinectomy for the management of RRD with PVR. We reviewed the theoretical background of mechanical forces occurring in RRD. Results: Detachment of the retina from the retinal pigment epithelium (RPE)/choroid is influenced by disequilibrium of several physical forces: tangential forces on the epiretinal membrane (T1 ) and radial traction on the retina FR exceeding the retinal adhesion force to the RPE (T1 + FR > FA ) . PVR may exaggerate the amounts of tangential and radial forces ( (T1 ) and FR ) that pull the retina off. Relaxing radial retinectomy, by the nature of its cutting pattern, may theoretically decrease the amounts of both forces, therefore restoring the equilibrium between tensile and adhesive forces on the retinal surface (T1 + FR = FA ). Conclusion: Relaxing radial retinectomy may potentially be applied in RRD with advanced PVR but has rarely been reported to date. Future studies are needed to evaluate its outcomes and long-term complications. Keywords: Rhegmatogenous retinal detachment, Proliferative vitreoretinopathy, Radial retinectomy, Vitrectomy, Relaxing retinectomy Background Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment [1] and is characterized by the presence of a retinal break as an entry point of fluid into the subretinal space, leading to separation of the neurosensory retina (NSR) from the retinal pigment epithelium (RPE) [2, 3]. Management of RRD is considered *Correspondence: [email protected] 2 Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Sardjito Eye Center, Dr. Sardjito General Hospital, Jalan Farmako Sekip Utara, Yogyakarta, Indonesia Full list of author information is available at the end of the article
very routine for vitreoretinal (VR) surgeons but can be very challenging when the condition progresses with the presence of proliferative vitreoretinopathy (PVR) [4, 5]. PVR is an abnormal cellular accumulation generating traction on the retina that may significantly reduce the anatomical success rate of RRD treatment due to the double burden and difficulty level of the surgery [5, 6]. Theoretically, in retinal detachment, mechanical forces caused by PVR play a key role in generating traction and ultimately reduce the success rate of retinal reattachment surgery [7]. Therefore, any procedures
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