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Primary Retinal Detachment

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104<br />

6 Minimal Segmental Buckling With Sponges and Balloons<br />

found that there is one break in 50% of detachments, two breaks in<br />

30%, and three or more breaks in 20%. Thus, after a meticulous<br />

preoperative and intraoperative search for the break, in about 50%,<br />

not more than one break has to be buckled. In addition, in general,<br />

multiple breaks are not distributed over the entire retinal circumference<br />

of the eye, but tend to be located within the quadrant of the<br />

primary break.<br />

Optimum segmental buckling aims to fit the various sizes<br />

and configurations of retinal breaks. There can be three or four<br />

segmental buckles to circumvent a cerclage. The complications<br />

of a cerclage tend to be: anterior segment ischemia, hypertension<br />

or hypotension, uveitis, decreased retinal and choroidal blood<br />

flow and eventual unilateral pigmentary dystrophy, constricted<br />

visual field,reduction in two-point discrimination,and diminished<br />

retinal activity or a reduced amplitude of the electroretinogram<br />

[27–32].<br />

<strong>Detachment</strong>s with multiple breaks and even with proliferative<br />

vitreoretinopathy (PVR) grade C1–C2 can be treated with segmental<br />

buckling and without drainage (Figs. 6.4–6.8). The segmental<br />

buckles may consist of radials, short circumferentials, or a combination<br />

of both, but without a cerclage.

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