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Primary Retinal Detachment

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178<br />

9 Repair of <strong>Primary</strong> <strong>Retinal</strong> <strong>Detachment</strong><br />

Fig. 9.1. A three-quadrant detachment with a horseshoe tear at 1:15<br />

adopted. Instead, the pendulum swung back to an extensive coagulation.<br />

Now, for the second time, the barrier concept was integrated<br />

into the treatment. Coagulations were placed posterior to<br />

the break, but, in addition, the barrier of coagulations was reinforced<br />

with a scleral resection. Subsequently, a polyethylene tube<br />

was embedded into the resection to create a higher wall. Thus,<br />

for the first time, a buckle was applied in detachment surgery to<br />

more effectively barricade the break (Figs. 9.1, 9.2). The break was<br />

Fig. 9.2. Scleral resection with an embedded polyethylene tube and<br />

drainage for repair of the three-quadrant detachment in Fig. 9.1. a The<br />

horseshoe tear was attached, but positioned on the anterior edge of the<br />

buckle and not sufficiently tamponaded. Diathermy coagulations were<br />

added around the tear, on the buckle, and additional lines of coagulations<br />

extended to the ora serrata. b The horseshoe tear leaked anteriorly, broke<br />

through the lines of coagulations before the adhesions were secure, and<br />

caused an anterior redetachment that progressed inferiorly and redetached<br />

the posterior retina

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