Primary Retinal Detachment

Repair of Primary Retinal Detachment 181
c
Fig. 9.3. Encircling buckle (cerclage), extensive diathermy coagulations,
and drainage for repair of the detachment in Fig. 9.1. a The horseshoe tear
was attached, but positioned on the anterior edge of the buckle and not
sufficiently tamponaded. b Anterior redetachment was confined by the
encircling buckle. c Anterior redetachment eventually broke over the inferior
buckle barrier and redetached the posterior retina
positioned at the anterior edge of the buckle and larger breaks were
not adequately tamponaded and would leak anteriorly and cause an
anterior redetachment, which descended behind the buckle, went
around the buckle inferiorly, and redetached the posterior retina.
The consequence could have been a more sufficient tamponade
of the leaking break. Instead, a more effective barrier was developed
in 1953, the segmental buckle barrier was extended for 360° –
for the first time – by Schepens [7] and in 1958 by Arruga [8]. The
cerclage operation with drainage of subretinal fluid represented a
maximum barrier for the leaking break. But here, as well, redetachments
developed (Fig. 9.3). Eventually the cerclage was widened in
the area of the tear with a polyethylene sleeve to buckle the anterior
edge of the tear. Later, various silicone forms for buckling were