Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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98<br />
6 Minimal Segmental Buckling With Sponges and Balloons<br />
was accompanied by serious complications, such as intraocular<br />
hemorrhages, which occurred in 15.6% of patients in our series, as<br />
reported in 1971 [7], in 16% as published by Blagojevic in 1975 [8],<br />
and in 6.9% as reported by Huebner and Boeke [9]. Additional<br />
complications consisted of choroidals in 8.6%, as reported by<br />
Toernquist and Toernquist in 1988 [10] and intraocular infection<br />
and incarceration of vitreous and retina, as described by Lincoff<br />
and Kreissig [11].<br />
A procedure without drainage to attach the retina would eliminate<br />
two major hazards of drainage: (1) perforation of choroid with<br />
its serious complications and (2) the subsequent intravitreal injection<br />
to restore lost volume, which adds the risk of an intraocular<br />
infection.<br />
The needed change was already “ante portas” in 1953 when<br />
Custodis [12] introduced a different approach to attach a retina.<br />
The procedure (1) eliminated drainage of subretinal fluid and the<br />
accompanying complications and (2) limited the coagulations and<br />
the buckle to the area of the break. The operation was in complete<br />
contrast to cerclage with drainage. Nondrainage of the Custodis<br />
technique was made feasible by the use of an elastic explant, the<br />
polyviol plombe, which was compressed by an intrascleral mattress<br />
suture over the detached retinal break. However, the sclera was<br />
treated by full-thickness diathermy, which subsequently proved<br />
detrimental to this exceptional technique. Due to the subsequent<br />
expansion of the compressed elastic plombe, the retinal break<br />
would be closed, and subretinal fluid would be absorbed. Thus,<br />
drainage was eliminated, and the intraoperative complications<br />
were reduced to a minimum. The simplicity of this Custodis principle<br />
was a concept of genius: “After the leaking break is closed,<br />
the pigment epithelium will pump out subretinal fluid and attach<br />
the retina.” But despite all, this exceptional technique was nearly<br />
abandoned, not because it did not work, but because of unexpected<br />
serious postoperative complications caused by the polyviol<br />
plombe compressed over full-thickness and diathermized sclera.<br />
The diathermized sclera became necrotic, and, if bacteria were