Transactions of the American Ophthalmological Society
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Trans Am Ophthalmol Soc · Jan 1999
Comparative StudyEvidence-based medicine regarding the prevention of retinal detachment.
To assess the quality of information in the literature regarding the prevention of retinal detachment in an effort to establish appropriate practice guidelines. ⋯ The current literature regarding prevention of retinal detachment does not provide sufficient information to strongly support prophylactic treatment of lesions other than symptomatic flap tears. Prospective randomized trials of prophylactic therapy are indicated. Eyes highly predisposed to retinal detachment should be considered for such studies.
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Patients with overcorrected strabismus (and several patients with undercorrection after extraocular muscle resection) underwent exploration of previously operated muscles, with the intention of advancing their tendons to prevent the need for surgery on additional muscles. Unexpectedly, it was found that, in many cases, an elongated scar segment of variable length was interposed between the muscle and its insertion site on the sclera. Laboratory investigations were carried out to elucidate the underlying mechanism(s) and to create an animal model of the disorder. ⋯ A lengthened or stretched, remodeled scar between an operated muscle tendon and sclera is a common occurrence and is a factor contributing to the variability of outcome after strabismus repair, even years later. This abnormality may be revealed by careful exploration of previously operated muscles. Definitive repair requires firm reattachment of tendon to sclera with nonabsorbable suture support.