Primary Retinal Detachment

98
6 Minimal Segmental Buckling With Sponges and Balloons
was accompanied by serious complications, such as intraocular
hemorrhages, which occurred in 15.6% of patients in our series, as
reported in 1971 [7], in 16% as published by Blagojevic in 1975 [8],
and in 6.9% as reported by Huebner and Boeke [9]. Additional
complications consisted of choroidals in 8.6%, as reported by
Toernquist and Toernquist in 1988 [10] and intraocular infection
and incarceration of vitreous and retina, as described by Lincoff
and Kreissig [11].
A procedure without drainage to attach the retina would eliminate
two major hazards of drainage: (1) perforation of choroid with
its serious complications and (2) the subsequent intravitreal injection
to restore lost volume, which adds the risk of an intraocular
infection.
The needed change was already “ante portas” in 1953 when
Custodis [12] introduced a different approach to attach a retina.
The procedure (1) eliminated drainage of subretinal fluid and the
accompanying complications and (2) limited the coagulations and
the buckle to the area of the break. The operation was in complete
contrast to cerclage with drainage. Nondrainage of the Custodis
technique was made feasible by the use of an elastic explant, the
polyviol plombe, which was compressed by an intrascleral mattress
suture over the detached retinal break. However, the sclera was
treated by full-thickness diathermy, which subsequently proved
detrimental to this exceptional technique. Due to the subsequent
expansion of the compressed elastic plombe, the retinal break
would be closed, and subretinal fluid would be absorbed. Thus,
drainage was eliminated, and the intraoperative complications
were reduced to a minimum. The simplicity of this Custodis principle
was a concept of genius: “After the leaking break is closed,
the pigment epithelium will pump out subretinal fluid and attach
the retina.” But despite all, this exceptional technique was nearly
abandoned, not because it did not work, but because of unexpected
serious postoperative complications caused by the polyviol
plombe compressed over full-thickness and diathermized sclera.
The diathermized sclera became necrotic, and, if bacteria were