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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

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