Primary Retinal Detachment

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6 Minimal Segmental Buckling With Sponges and Balloons
found that there is one break in 50% of detachments, two breaks in
30%, and three or more breaks in 20%. Thus, after a meticulous
preoperative and intraoperative search for the break, in about 50%,
not more than one break has to be buckled. In addition, in general,
multiple breaks are not distributed over the entire retinal circumference
of the eye, but tend to be located within the quadrant of the
primary break.
Optimum segmental buckling aims to fit the various sizes
and configurations of retinal breaks. There can be three or four
segmental buckles to circumvent a cerclage. The complications
of a cerclage tend to be: anterior segment ischemia, hypertension
or hypotension, uveitis, decreased retinal and choroidal blood
flow and eventual unilateral pigmentary dystrophy, constricted
visual field,reduction in two-point discrimination,and diminished
retinal activity or a reduced amplitude of the electroretinogram
[27–32].
Detachments with multiple breaks and even with proliferative
vitreoretinopathy (PVR) grade C1–C2 can be treated with segmental
buckling and without drainage (Figs. 6.4–6.8). The segmental
buckles may consist of radials, short circumferentials, or a combination
of both, but without a cerclage.