Primary Retinal Detachment

184
9 Repair of Primary Retinal Detachment
As a result, minimal segmental buckling with sponge(s) or a
balloon without drainage represents a second option for repair of
a primary retinal detachment in use at the beginning of the twentyfirst
century (Fig. 9.5).
Apart from these two options for closing the leaking break with
a circular barrier (cerclage) or a segmental buckle (sponge or
balloon) limited to the break, both of which are extraocular, two
options for an intraocular approach developed. An intraocular gas
bubble to tamponade a leaking break was introduced – now for the
second time. Instead of air, SF6 was injected by Norton and Lincoff
[20, 21]. This technique required drainage of subretinal fluid with
its complications.
In 1979, Kreissig [22] applied – for the first time – intraocular
SF6, an expanding gas, without prior drainage in selected detachments.
The procedure was named the expanding-gas operation
without drainage. However, an increased rate of postoperative
proliferative vitreoretinopathy (PVR) caused Kreissig
to reserve intraocular gas for problematic breaks not suitable
for buckling. Subsequently to reduce the morbidity of intraocular
gas, Kreissig developed the balloon-gas procedure which enables
to inject primarily a larger bubble of a gas with a shorter intraocular
duration [23]. To close a leaking break with a gas bubble and
without prior drainage was introduced again – for the second time
– by Hilton [24] and simultaneously by Dominguez [25] in 1986.
Hilton called the procedure pneumatic retinopexy which represents
a third option for repair of a primary retinal detachment
in use at the beginning of the twenty-first century (Fig. 9.6a).
When supplemented by 360° barrier coagulations, it is no longer a
procedure limited to the break (Fig. 9.6b) [26].
Pneumatic retinopexy has become a popular procedure, despite
the fact that it has a greater morbidity for closing the leaking break
than minimal segmental buckling without drainage. Its popularity
is due to its relative simplicity.
To reduce the postoperative complications of intraocular gas,
a vitrectomy was added [27]. The rationale was that a vitrectomy