Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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Outlook 139<br />
4. The operation should provide a maximum of long-term visual<br />
function, not jeopardized by secondary complications during<br />
the prolonged life expectancy of the patient treated<br />
Outlook<br />
Minimal segmental buckling by a sponge or a balloon and without<br />
drainage of subretinal fluid is the ultimate development of scleral<br />
buckling introduced by Schepens and Custodis and subsequently<br />
refined by Lincoff, Kreissig, and others. Minimal segmental<br />
buckling without drainage provides an optimum of early and late<br />
anatomical and visual results: retinal attachment results after one<br />
operation in 91% and after reoperation in 97%. However, to obtain<br />
this rate of attachment requires an expertise in biomicroscopy<br />
and binocular indirect ophthalmoscopy to find the breaks preoperatively<br />
and at surgery to localize these breaks correctly and to<br />
adequately position the segmental buckle beneath them without<br />
drainage of subretinal fluid. However, this “Art of minimal segmental<br />
buckling” [25, 26] has a learning curve.<br />
<strong>Detachment</strong>s in pseudophakic eyes today are almost routinely<br />
assigned to vitrectomy for primary repair. This may occur even<br />
when the break can be visualized preoperatively and would respond<br />
to a segmental buckle without drainage. For these eyes in<br />
which the break cannot be found because the peripheral retina is<br />
obscured by a narrow pupil or capsule opacities, a vitrectomy to<br />
provide better access for viewing the anterior retina may provide a<br />
better prognosis than prospective buckling, being based on the<br />
contour of the detachment, or a cerclage.<br />
However, we have to keep in mind that the resources available<br />
for ophthalmology are diminishing as life expectancy increases<br />
and new treatments for various macular and retinal diseases become<br />
available. This expanding spectrum includes invasive and<br />
noninvasive, but expensive, treatment modalities. All this may<br />
force us to reconsider how to spend the limited resources for the<br />
increasing number of patients.