Primary Retinal Detachment

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9 Repair of Primary Retinal Detachment
Fig. 9.1. A three-quadrant detachment with a horseshoe tear at 1:15
adopted. Instead, the pendulum swung back to an extensive coagulation.
Now, for the second time, the barrier concept was integrated
into the treatment. Coagulations were placed posterior to
the break, but, in addition, the barrier of coagulations was reinforced
with a scleral resection. Subsequently, a polyethylene tube
was embedded into the resection to create a higher wall. Thus,
for the first time, a buckle was applied in detachment surgery to
more effectively barricade the break (Figs. 9.1, 9.2). The break was
Fig. 9.2. Scleral resection with an embedded polyethylene tube and
drainage for repair of the three-quadrant detachment in Fig. 9.1. a The
horseshoe tear was attached, but positioned on the anterior edge of the
buckle and not sufficiently tamponaded. Diathermy coagulations were
added around the tear, on the buckle, and additional lines of coagulations
extended to the ora serrata. b The horseshoe tear leaked anteriorly, broke
through the lines of coagulations before the adhesions were secure, and
caused an anterior redetachment that progressed inferiorly and redetached
the posterior retina