Primary Retinal Detachment

36
3 Encircling Operation with Drainage for Primary Retinal Detachment
Fig. 3.1. An Arruga suture was placed 14 mm posterior to the limbus to
protect the posterior segment from the “porous” anterior retina
of constriction. Constriction could lead to intrusion of the suture
into the eye and narrowing of the lid fissure [9], but more often it
would lead to ocular ischemic symptoms: lid edema, chemosis,
uveitis and ocular hypotension, also described as the “string syndrome”
[10].
At about the same time, Schepens recognized the imperfect
location of an equatorial circling suture, which walled off anterior
breaks without really buckling or closing them. He wrote that
“Such a barrage forms a dyke, which limits the detachment to the
area surrounding the untreated retinal breaks and protects the
portion of the retina which has potential usefulness” [2]. The location
(latitude) of the circling polyethylene tube was determined
by the posterior edge of the most posterior retinal break. Ideally,
all breaks of similar latitude would come to lie on the anterior slope
or the crest itself, which would follow as closely as possible “the
great circle of the eyeball” [2].