Primary Retinal Detachment

Chapter 3
Encircling Operation with Drainage
for Primary Retinal Detachment
Hermann D. Schubert
Encircling circumferential buckles and drainage, also known as
“scleral buckling”, were introduced by Arruga and Schepens [1, 2]
in the 1950s. Encircling traces its roots to circumferential dissection
[3], barrier diathermy [4] and the buckle as practiced by
Jess [5] and Custodis [6]. Drainage can be traced back to repeated
scleral punctures to flatten retinal elevations (ponction sclerale)
[7] and Jules Gonin’s ignipuncture technique [8]. This chapter will
review the reasons why eyes were originally encircled, why the
procedure works in a majority of cases, and why eyes are still being
encircled and drained today, despite the procedure’s inherent
morbidity.
Origins of Encircling: Arruga and Schepens
Arruga devised a simple procedure using a nylon, silk or supramid
suture to encircle the equator of the eye (Fig. 3.1). Breaks were
either diathermized according to Gonin’s principle or isolated by a
barrier: “Je diathermise la region des dechirures, ou aux endroits
qu’il faut isoler par un barrage” [1].
Arruga’s operation consisted of a treatment of breaks, creation
of barriers, and volume reduction. Fluid was drained from and air
was injected into the eye to replace lost volume. Tying a suture at
the equator (14 mm posterior to the limbus) both reduced the volume
of the ocular cavity, relieving vitreous traction, and protected
the posterior segment from the torn anterior segment, at the price