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Fixing Retinal Detachments

Retinal detachments do not only necessitate a medical emergency; they can cause permanent vision loss if not promptly treated. During the retinal detachment session at the recently held Asia-Pacific Academy of Ophthalmology (APAO 2017) meeting in Singapore, vitreoretinal surgeons shared clinical pearl in the management of complex retinal detachments

It is well known that on average, about 70% of retinal detachments are complicated by proliferative vitreoretinopathy (PVR). This is due to the proliferation or contraction of the cellular membranes that are in the hyaloid of the retina or on the surface of the retina. In fact, although surgeons achieve anatomical success in more than 90% of retinal detachments, primary prevention of PVR remains an issue. 

“These tractional forces then result in reopening retinal breaks, creating new breaks or distorting the retina. It has been described as a scaring process amplified by the inflammation,” said Dr. Lee Shu Yen, MBBS, MMed(Ophth), FRCS(Ed), FAMS, Senior Consultant, Surgical Retina Department, Singapore National Eye Centre. 

At risk of complex retinal detachments, highlighted Dr. Lee, are basically eyes that have giant or large breaks, multiple breaks, eyes of patients that have a history of uveitis, patients presenting with vitreous hemorrhage, and patients presenting with choroidal detachment. 

“Sometimes as you wait for the massive choroidal detachment to subside, this may result to surgery later. Or when a patient has a history of penetrating trauma…in such cases, we need quite a lot of work to undo all these,” she added.

Meanwhile, presenting cases of retinal detachments associated with trauma and intraocular foreign bodies, Dr. Paisan Ruamviboonsuk, M.D., Immediate Past President, The Royal College of Ophthalmologists of Thailand; Regional Secretary, APAO; Council Member, APVRS; Secretary General, ASEAN Ophthalmology Society; Previous President, Thai Retina Society (2009-2014), agreed that such cases which can lead to penetrating trauma pose quite a challenge to surgeons. 

Furthermore, secondary PVR, emphasized Dr. Lee, is a “hot” retinal detachment case “because you thought you have done a good job and then one to two months later the retina re-detaches,” she explained. 

“You have to be aware of these eyes that have already presented with some form of low grade PVR, vitreous hemorrhage or history of uveitis, because sometimes you will miss the break. The problem is, successful sealing of all retinal breaks does not always give protection against PVR because it is quite common that you see re-detachment one month later,” shared Dr. Lee. 

Also, Dr. Lee noted the importance of “completing” surgery in retinal detachments. “Otherwise there would be a scaffold that the harvest process will continue on to,” she said. 

“You need to address the issues of the vitreous space, you need to remove all the surface membranes that are exerting tractional forces. In terms of retinal foreshortening you need a good broad buckle. Sometimes you need to do a relieving retinectomy if the broad buckle is not good enough. And sometimes you need to flip the retina over to remove the sub-retinal bonds that are tending the retina up,” Dr. Lee shared. 

Adding to the clinical experiences shared by Dr. Lee and Dr. Ruamviboonsuk, Dr. Andrew Chang, MBBS(Hons), PhD (Syd), FRANZCO, FRACS, Associate Clinical Professor, University of Sydney and Medical Director of Sydney Retina Clinic and Day Surgery in Australia, reported that heavy liquid tamponade is of good use in treating complex retinal detachments. 

“It’s heavy and so pushes the retina down. It is clearer so we can see what we are doing within the eye. It has a moderate surface tension and low viscosity, therefore easy to handle,” explained Dr. Chang. He then presented a few surgical videos in treating retinal detachment using heavy liquid tamponade and concluded that based on his clinical experience, short-term heavy liquid tamponade is useful in treating complex retinal detachments.

Dr Shu Yen Lee

Dr. Lee Shu Yen

After obtaining her post-graduate degrees in ophthalmology at the National University Singapore (NUS), Dr. Lee Shu Yen completed a 2-year fellowship in vitreoretinal surgery at the Singapore National Eye Centre (SNEC) and worked with Prof. Ian Constable and Prof. Ian MacAllister at the Lions Eye Institute in Western Australia. Dr. Lee’s research interests are in retinal detachment, diabetic retinopathy, retinal complications of myopia, gene therapy for retinal disorders. Outside of her career in ophthalmology, Dr. Lee is an avid tennis player. Email:

Dr Andrew Chang

Dr. Andrew Chang

A vitreoretinal ophthalmologist, Dr. Andrew Chang graduated from University of Sydney Medical School with honors. He underwent registrar training at the Sydney Eye Hospital and fellowship training at Royal Victorian Eye and Ear Hospital and in the United States. Dr. Chang is actively involved in basic science and clinical trials research, receiving funding from both Australia and the United States. Also, Dr. Chang is fully committed to international ophthalmology through his commitments with the Asia-Pacific Vitreoretinal Society (APVRS), NSW RANZCO, Federal RANZCO Council and the Department of Health Australia. [email:]

Dr. Paisan Ruamviboonsuk

Dr. Paisan Ruamviboonsuk received his certificate of specialization on vitreous and retina diseases from the Albert Einstein College of Medicine, New York. Currently, he holds the positions of chairman of the Department of Medical Policy Development and Strategic Planning and assistant hospital director at the Center of Medical Excellence, Rajavithi Hospital, Bangkok, Thailand. Dr. Ruamviboonsuk also serves as a retinal specialist at the Center of Excellence for Vitreous and Retina Diseases in the same hospital. [email:

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