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Primary Retinal Detachment

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44<br />

3 Encircling Operation with Drainage for <strong>Primary</strong> <strong>Retinal</strong> <strong>Detachment</strong><br />

It is of note that two of the series [15, 37] compared scleral buckling<br />

(78–100% encircling and 72–85% drainage) to pneumatic<br />

retinopexy. Scleral buckling was therefore used synonymously<br />

with encircling and drainage in the recent literature and we can assume<br />

that it represents the standard of care.<br />

Encircling at Wills Eye Hospital in 1985<br />

To test this hypothesis, that encircling and drainage are still the<br />

primary procedure, the author reviewed 100 consecutive scleral<br />

buckling procedures done at Wills Eye Hospital from 1985 to 1986.<br />

Eleven members of the retina service encircled primary detachments<br />

in 83% and drained in 73% of cases, consistent with the<br />

literature.<br />

Air or gas was injected in 6%. The extent of the detachment was<br />

one quadrant in 10%, two quadrants in 52%, three quadrants in 21%<br />

and four quadrants in 17%. The average area of detachment was 2.9<br />

quadrants.<br />

The preferred buckling procedure consisted of a 3-mm encircling<br />

band used in 83%, combined with a 7-mm explant which was<br />

used in 73%. The explant covered 2.3 quadrants on average so that<br />

in 49% of all cases it covered the entire extent of the detachment<br />

(Fig. 3.6). The primary success rate was around 90%. The author<br />

had no follow-up after discharge from the hospital, except for<br />

re-admissions.<br />

It is easy to see why this skillfully executed procedure had a high<br />

success rate. Careful preoperative study was mandatory as was a<br />

detailed retinal drawing. (Encircling and drainage did not mean<br />

that the study of the retina was optional). Patients were admitted<br />

the day before surgery, were studied in the evening and stayed<br />

overnight to help flatten the detachment. During surgery, all breaks<br />

were carefully marked on sclera to ensure their placement on the<br />

crest or anterior slope of the buckle. Cryopexy was applied to<br />

breaks, lattice and suspicious retinal lesions. Since the majority of

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