Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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110<br />
6 Minimal Segmental Buckling With Sponges and Balloons<br />
Limits of Minimal Segmental Buckling Without Drainage<br />
There are limits to minimal segmental buckling; however, more<br />
than 90% of rhegmatogenous detachments can be treated by extraocular<br />
minimal buckling alone – the remaining 10% can be divided<br />
into three major categories.<br />
First Category of Difficult <strong>Detachment</strong>s<br />
In this type of detachments, the limits of the minimal procedure<br />
are exceeded if the tears are posterior (in about 1%),multiple at different<br />
latitude (in 2–3%), or with a circumferential extent greater<br />
than 70° (in 1–2%). A tamponade with an expanding gas bubble<br />
without drainage represents the next level of a minimal surgery for<br />
these conditions, but it requires an intraocular injection. Consequently,<br />
in this first category, a gas tamponade will suffice.A vitrectomy<br />
will be needed for the rare situation of a giant tear of less than<br />
or equal to 150° with an overhanging flap or, as in some hands, if<br />
the tear is greater than 90°.<br />
Second Category of Difficult <strong>Detachment</strong>s<br />
These are detachments with local vitreous traction that caused the<br />
redetachment of a horseshoe tear that had been buckled or detachments<br />
with proliferative vitreoretinopathy in more than two quadrants.<br />
In these detachments, a primary vitrectomy may be indicated.<br />
However, it is not indicated per se if the starfolds are more than<br />
1 clock hour from the tear to be buckled. In these difficult detachments,<br />
buckling first is advisable (Fig. 6.8) [33–35]. However, if one<br />
decides upon a vitrectomy, it has to be combined with a meticulous<br />
removal of proliferative preretinal membranes and the anterior vitreous.<br />
Why? Because the additional gas tamponade, combined with<br />
the vitrectomy, can provoke anterior vitreoretinal proliferation.