Primary Retinal Detachment

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6 Minimal Segmental Buckling With Sponges and Balloons
In the following, minimal segmental buckling without drainage
of subretinal fluid will be described: its origin, subsequent development
of two variations and their specifics, applicability, limits, complications,
anatomical and functional results, and the disadvantages
and advantages of this extraocular minimal surgery.
Origins of Minimal Segmental Buckling Without Drainage
Minimal segmental buckling without drainage for repair of a
primary rhegmatogenous retinal detachment is an extraocular
technique in which the buckle and the coagulations are limited to
the area of the break. The two components of this procedure can be
traced back over several decades. The present minimal surgery
developed in small steps over the years. Eliminating drainage of
subretinal fluid and applying the surgery only in the area of the
break was a change from treating the entire extent of the detachment
to a surgery of the retinal break (Fig. 6.1).
For the first time since Gonin (1929), the coagulations were limited
to the break [1]. However, the advantage of this limited and
focused treatment was given up over the years, and coagulation of
the entire periphery of the detached retina again was recommended
to create a secure barrier against redetachment [2, 3]. Coagulating
limited to the leaking break was taken up again – for the second
time – by Rosengren in 1938 [4]. However, with this procedure,
redetachments occurred because the intraocular duration of the
air bubble was sometimes too short for a sufficient adhesion to
develop around the break. Consequently, the barrier concept was
integrated again into the treatment of retinal detachment. This
resulted in coagulations over the entire retinal periphery, and,
subsequently, a circumferential buckle was added by Schepens in
1957 [5] and Arruga in 1958 [6]. Thus, the cerclage operation with
drainage of subretinal fluid evolved.
Yet, drainage, which was applied with this procedure, represented
a dangerous and vision-threatening complication. The procedure