Primary Retinal Detachment

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