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Primary Retinal Detachment

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Are Encircling and Drainage Still Popular Methods? 43<br />

Fig. 3.5. Subretinal blood after drainage. It is parafoveal, but vision remained<br />

poor<br />

Are Encircling and Drainage Still Popular Methods?<br />

In light of the above tales of both success and morbidity, are<br />

encircling and drainage still done? The short answer is that encircling<br />

with drainage, as opposed to minimal segmental buckling<br />

without drainage [36], requires less-accurate meridional localization<br />

of all breaks, is subsequently somewhat easier to do, and<br />

works at the short-term risk of hemorrhage and long-term risk of<br />

choroidal ischemia.<br />

In more recent (1982–2002) clinical series on scleral buckling<br />

[15, 26, 37, 38], encircling was practiced in 43–100% (average 74%)<br />

and was combined with drainage in 72–85% (average 78%) of total<br />

cases. Gas was injected in 26–32% in two series; this procedure is<br />

also known as “pneumatic buckle” [15, 37]. <strong>Primary</strong> success ranged<br />

from 78% to 96% (average 85%). Obstacles to success were<br />

aphakia/pseudophakia, whereas the main benefit of encircling<br />

relative to alternate procedures was found to be the low incidence<br />

of secondary tears (1.3% versus 18–20%) [15].

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