Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Chapter 6<br />
Minimal Segmental Buckling With Sponges<br />
and Balloons for <strong>Primary</strong> <strong>Retinal</strong> <strong>Detachment</strong><br />
Ingrid Kreissig<br />
Introduction<br />
We have known for more than 70 years that a retinal detachment is<br />
caused by a break, as Gonin postulated in 1929 [1]. The postulate is<br />
no longer in doubt; however, the discussion on how to close it is ongoing.<br />
Therefore, the best procedure to repair a rhegmatogenous<br />
retinal detachment should be one with a minimum of trauma, a<br />
maximum of primary attachment, a minimum of reoperations<br />
with a minimum of secondary operations, e.g., cataract, glaucoma,<br />
etc., and a maximum of long-term visual function.<br />
By the beginning of the twenty-first century, four main surgical<br />
techniques had evolved to attach a primary rhegmatogenous retinal<br />
detachment, i.e., cerclage with drainage, pneumatic retinopexy,<br />
primary vitrectomy, and minimal segmental buckling without<br />
drainage (extraocular minimal surgery). All four procedures have<br />
one issue in common: to find and close the leaking break that<br />
caused the retinal detachment and that would cause a redetachment<br />
if not closed. This issue is independent of (1) whether the<br />
surgery is limited to the area of the break or extends over the entire<br />
detachment and (2) whether it is performed as an extraocular or<br />
intraocular procedure.<br />
Since the rhegmatogenous detachments present a wide range of<br />
findings, each of the four procedures could cover a specific type of<br />
detachment. However, the indication of each is somehow in a gray<br />
zone, since de facto it depends on the expertise of the individual<br />
detachment surgeon.