Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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138<br />
6 Minimal Segmental Buckling With Sponges and Balloons<br />
Table 6.5. Reasons of primary failure (n=91) after one operation with<br />
minimal segmental sponge buckle(s) without drainage of 962 primary<br />
retinal detachments<br />
Series Detach- Cause of primary failure Total<br />
ment<br />
Missed Inadequate PVR Choroidals<br />
break buckle<br />
First 752 31+2 a 27 17 3 80<br />
[21, 39]<br />
Second 107 4 4 – – 8<br />
[26, 40]<br />
Third 35 – – – – –<br />
[41]<br />
Fourth 68 2 1 – – 3<br />
[42]<br />
Total 962 39 32 17 3 91<br />
a Macular hole<br />
�<br />
71 (78%)<br />
(series 1–4) was 39 times a missed break and 32 times an inadequate<br />
buckle. Thus, failure to close the leaking break accounted for<br />
71 of 91 failures or 78% (Table 6.5).<br />
Thus, a leaking break still remains the main cause of primary<br />
failure, and vitrectomy has not significantly altered this. This validates<br />
the postulate of Gonin, defined more than 70 years ago: the<br />
retinal break causes the detachment.<br />
However, in the future, the requirements of an optimal surgery<br />
for repair of a primary retinal detachment might be more specific:<br />
1. Just one operation should attach the retina once and for all<br />
2. The surgery should have a minimum of morbidity<br />
3. The procedure should be done on a small budget and under<br />
local anesthesia