Primary Retinal Detachment

Functional Results 131
to either side of the sponge. When a very anterior circumferential
buckle was needed, it was placed external to the muscle [44]. Most
important were daily ocular motility exercises during the first
postoperative week to counteract the development of adhesions
around the muscle. This was done independent of the state of the
retina.As a result, no sponge had to be removed because of diplopia.
In the fifth series (n=500), a temporary balloon buckle was applied,
which was removed after 1 week. In this series, there was no
buckle infection or exposure. Diplopia was sometimes present
when the balloon was in place, but diplopia remitted in all eyes
within hours after the balloon was removed.
Functional Results
Since the end of the 1960s, detachment surgery has been concentrating
not only on anatomical results, but also on visual function
[45–49] – both short-term recovery after surgery and long-term
visual acuity.
In the first series, visual function was not described. In the
remaining four series, treated with sponges or balloons, the mean
visual acuity was 0.67 after 2 years (Table 6.4). The two questions
that arise are: (1) Would visual acuity decline over years? (2) Would
the presence of a segmental buckle over years cause a secondary
deterioration of visual function?
These pending questions can be answered by the second series of
107 primary retinal detachments treated by minimal segmental sponge
buckle(s) without drainage and with a complete follow-up of 15 years
[40]. The mean preoperative visual acuity was 0.3; it improved to
0.5 during the first 6 months after surgery, and reached a maximum
of 0.6 at 1 year. The increase was statistically significant (P