Primary Retinal Detachment

Chapter 6
Minimal Segmental Buckling With Sponges
and Balloons for Primary Retinal Detachment
Ingrid Kreissig
Introduction
We have known for more than 70 years that a retinal detachment is
caused by a break, as Gonin postulated in 1929 [1]. The postulate is
no longer in doubt; however, the discussion on how to close it is ongoing.
Therefore, the best procedure to repair a rhegmatogenous
retinal detachment should be one with a minimum of trauma, a
maximum of primary attachment, a minimum of reoperations
with a minimum of secondary operations, e.g., cataract, glaucoma,
etc., and a maximum of long-term visual function.
By the beginning of the twenty-first century, four main surgical
techniques had evolved to attach a primary rhegmatogenous retinal
detachment, i.e., cerclage with drainage, pneumatic retinopexy,
primary vitrectomy, and minimal segmental buckling without
drainage (extraocular minimal surgery). All four procedures have
one issue in common: to find and close the leaking break that
caused the retinal detachment and that would cause a redetachment
if not closed. This issue is independent of (1) whether the
surgery is limited to the area of the break or extends over the entire
detachment and (2) whether it is performed as an extraocular or
intraocular procedure.
Since the rhegmatogenous detachments present a wide range of
findings, each of the four procedures could cover a specific type of
detachment. However, the indication of each is somehow in a gray
zone, since de facto it depends on the expertise of the individual
detachment surgeon.