Primary Retinal Detachment

Temporary Balloon Buckle Without Drainage 113
earlier animal experiments on the strength of the cryosurgical
adhesion and the time it takes to develop a sufficiently strong adhesion.
Thus, 10 years after the experimental data on the strength of
the cryosurgical retinal adhesion were obtained, it was confirmed
by the temporary balloon buckle, placed under the break surrounded
by cryosurgical lesions and removed after a week. The balloon
operation is performed under topical or subconjunctival anesthesia.
No sutures have to be placed to fixate the balloon buckle, and
the small conjunctival wound of 1–2 mm needed to insert the
balloon catheter will close by itself after withdrawal of the balloon.
After that, sustained attachment will depend exclusively on the
strength of the retinal adhesion, induced by transconjunctival cryopexy
prior to insertion of the balloon, or by laser, applied postoperatively,
after attachment of the break on the balloon buckle.
The balloon operation represents the ultimate refinement of
closing a leaking break ab externo and without leaving a buckle at
the wall of the eye. The break is sealed off by surrounding retinal
adhesions. It represents a procedure with a minimum of surgical
trauma. The balloon operation follows the postulate of Gonin – to
find the break and to limit the treatment to the area of the leaking
break – and the principle of Custodis – not to drain subretinal fluid.
With the balloon, the last complications of segmental buckling,
infection or extrusion, and diplopia are eliminated.
Some detachments, which were treated with the temporary
balloon buckle, will be depicted:
1. A detachment with a break under a rectus muscle is an optimal indication
(Fig. 6.10), since after withdrawal of the balloon, diplopia
disappears.
2. A total pseudophakic detachment with an apparent circular anterior
traction line (which is, in fact, the vitreous base), capsular
remnants, and no certain break (Fig. 6.11). The treatment consists
here as well of a temporary balloon buckle in the suspected area
to test for the presence of a break; after attachment, the so-called
traction line tends to disappear.