96 6 Minimal Segmental Bu

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96 6 Minimal Segmental Buckling With Sponges and Balloons In the following, minimal segmental buckling without drainage of subretinal fluid will be described: its origin, subsequent development of two variations and their specifics, applicability, limits, complications, anatomical and functional results, and the disadvantages and advantages of this extraocular minimal surgery. Origins of Minimal Segmental Buckling Without Drainage Minimal segmental buckling without drainage for repair of a primary rhegmatogenous retinal detachment is an extraocular technique in which the buckle and the coagulations are limited to the area of the break. The two components of this procedure can be traced back over several decades. The present minimal surgery developed in small steps over the years. Eliminating drainage of subretinal fluid and applying the surgery only in the area of the break was a change from treating the entire extent of the detachment to a surgery of the retinal break (Fig. 6.1). For the first time since Gonin (1929), the coagulations were limited to the break [1]. However, the advantage of this limited and focused treatment was given up over the years, and coagulation of the entire periphery of the detached retina again was recommended to create a secure barrier against redetachment [2, 3]. Coagulating limited to the leaking break was taken up again – for the second time – by Rosengren in 1938 [4]. However, with this procedure, redetachments occurred because the intraocular duration of the air bubble was sometimes too short for a sufficient adhesion to develop around the break. Consequently, the barrier concept was integrated again into the treatment of retinal detachment. This resulted in coagulations over the entire retinal periphery, and, subsequently, a circumferential buckle was added by Schepens in 1957 [5] and Arruga in 1958 [6]. Thus, the cerclage operation with drainage of subretinal fluid evolved. Yet, drainage, which was applied with this procedure, represented a dangerous and vision-threatening complication. The procedure
Minimal Segmental Buckling Without Drainage 97 Fig. 6.1. Minimal segmental buckling without drainage, so-called extraocular minimal surgery. The treatment is limited to the area of the break and not determined by the extent of the detachment. The small (top left) and the more extensive detachment (top right) are caused by the same horseshoe tear at 1:00. The treatment of both is the same, consisting of buckling the tear either by a segmental sponge (as depicted) or a temporary balloon without drainage of subretinal fluid
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Ingrid Kreissig (Ed.) Primary Retin
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Professor Dr. med. Ingrid Kreissig
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Contents 1 The History of Retinal D
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List of Contributors Gary W. Abrams
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List of Contributors XI Hermann D.
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2 Helmholz in 1850 made an accurate
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4 (vitreous, gelatin) into the ante
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6 with scleral resection that set t
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8 ditis [72-74].Temperatures up to
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10 1 The History of Retinal Detachm
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16 ion [147]. Perfluorocarbon liqui
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26 2 Prophylaxis in Fellow Eye of P
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32 found that eyes with pre-existin
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36 3 Encircling Operation with Drai
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Page 54 and 55: 44 3 Encircling Operation with Drai
Page 64 and 65: Chapter 4 Pneumatic Retinopexy for
Page 66 and 67: Technique 57 Case Selection Proper
Page 68 and 69: Technique 59 Table 4.1. Gas charact
Page 70 and 71: Technique 61 solution; however,thes
Page 72 and 73: Technique 63 gas reflux. Following
Page 74 and 75: Complications: Prevention and Manag
Page 76 and 77: New Possibilities 67 ing on type an
Page 78 and 79: Results 69 Table 4.7 (continued) Au
Page 80 and 81: Discussion 71 surgical failures. Fa
Page 82 and 83: Discussion 73 Disadvantages of PR A
Page 84 and 85: References 75 situations, then to p
Page 86 and 87: References 77 24. Tornambe PE, Hilt
Page 88 and 89: References 79 51. Pournaras CJ, Don
Page 90 and 91: Chapter 5 Vitrectomy for the Primar
Page 92 and 93: Indications 83 Table 5.1. Indicatio
Page 94 and 95: Indications 85 Fig. 5.2. The vitreo
Page 96 and 97: Surgical Technique 87 vitrectomy an
Page 98 and 99: Outcomes 89 will be visible under a
Page 100 and 101: Outcomes 91 almost no persistent su
Page 102 and 103: References 93 7. Heimann H, Bornfel
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Page 108 and 109: 100 the operating table with the re
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Page 132 and 133: 124 c Fig. 6.14c 6 Minimal Segmenta
Page 134 and 135: Table 6.1. Preoperative characteris
Page 136 and 137: Table 6.3. Final attachment after m
Page 138 and 139: 130 Choroidals In 4 of the 1,462 de
Page 140 and 141: Table 6.4. Visual acuity at 2 years
Page 148 and 149: 140 Probably, the future question n
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146 7 Pharmacological Approaches to
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152 heparin was published in eyes u
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154 search for compounds with hepar
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Chapter 8 Systematic Review of Effi
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Materials and Methods 163 Table 8.2
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Discussion 165 30% 25% 20% 15% 10%
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Discussion 167 Fig. 8.2. The small
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Conclusion 169 vitrectomy and searc
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References 171 8. Brazitikos PD, D
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References 173 34. Gunduz K, Gunalp
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References 175 63. Schepens CL (195
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178 9 Repair of Primary Retinal Det
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180 a b Fig. 9.3a,b. Legend see pag
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186 a b 9 Repair of Primary Retinal
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188 might eliminate traction on the
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Chapter 10 Retinal Detachment Repai
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Retinal Detachment Repair: Outlook
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References 207 It is impossible to
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210 C Campbell 7 case selection 57,
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212 M Machemer 13 macular - complic
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214 retinal - detachment - - bilate
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Primary Retinal Detachment

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