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10 Retinal Detachment Repair: Outlook for the Future
Fig. 10.2. Balloon buckle in place closing retinal break
treatment. For this reason, much of the debate revolves around
theory and philosophy, not hard clinical data. There is little doubt
that the most minimal operation that would be highly effective
would be the procedure of choice. Highly effective should include
minimal complications and inconveniences, such as the induction
of refractive error (Lincoff, Kreissig) [1]. In this regard, the classical
radial sponge (Fig. 10.1) or the balloon buckle (Fig. 10.2) remains
the gold standard for many, due to the extraocular nature of the
surgery and low complication rate. These procedures shared in
common extraocular placement of a bulky device,which reapposes
or nearly apposes the neurosensory retina and retinal pigment
epithelium/choroicapillaris. By bringing these two layers in close
proximity, the rate of fluid flow under the retina is limited and
the pumping action of the pigmented epithelium overcomes the
leakage of fluid through the retinal tear; thus the retina reattaches.
The use of retinopexy is a backup procedure to further prevent
fluid leakage, causing a permanent scar or adhesion of the two
layers (Figs. 10.3 and 10.4). Unfortunately, segmental buckling is not