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Primary Retinal Detachment

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124<br />

c<br />

Fig. 6.14c<br />

6 Minimal Segmental Buckling With Balloon<br />

Fig. 6.14. Balloon as late reoperation of proliferative vitreoretinopathy<br />

(PVR)-C2 detachment. a A three-quadrant detachment with PVR and<br />

starfolds in two quadrants in an eye with a previous buckle operation with<br />

diathermy and a tear anterior to the buckle at 9:00. As minimal approach<br />

for reoperation in presence of diathermized sclera, a parabulbar balloon<br />

was selected. b After balloon operation (6 months): The macula had already<br />

attached 2 days after surgery. At 6 months, a residual traction detachment<br />

with concave contours and concave surface is persisting; the macula is still<br />

attached. c After balloon operation (4 years): The traction detachment has<br />

flattened, only faint remnants of starfolds are visible<br />

All of the listed advantages can be achieved by applying a temporary<br />

and not suture-fixated balloon buckle without drainage as treatment<br />

for a primary retinal detachment. But the “conditio sine qua<br />

non” for success with this minimal procedure is experience in the<br />

non-drainage operation. The surgeon has to be an expert in indirect<br />

binocular ophthalmoscopy and has to be able to locate a balloon<br />

correctly in the parabulbar space beneath a highly detached break.

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