Primary Retinal Detachment

Complications of Encircling 39
Fig. 3.3. Pathological specimen of an enucleated eye with a large buckle
which had caused motility problems
purse-string syndromes as well as short- and long-term effects of
choroidal ischemia and reduced pulse amplitude [17, 18].
Some of these events can be controlled with careful technique.
Conjunctival scarring and chronic dry eye can be reduced by
meticulous attention to Tenon’s capsule and careful dual layer closure.
(It is unfortunate that closure is at the end of a challenging
and tiring operation and is often delegated without much supervision).
Strabismus can be reduced by careful handling of orbital tissues
and muscle retraction and by choosing small instead of large
buckles [19–21] (Fig. 3.3).
Meticulous restoring of the anatomy will limit scarring. Motility
can be improved by postoperative ocular exercise. Erosion and
string syndrome can be avoided by limiting constriction to 10%
[22] (Fig. 3.4). Overzealous constriction (“high and dry”) can be
corrected later by cutting the band. More difficult post-surgical
judgements are presented by insidious choroidal ischemia and
reduced pulse amplitude [17, 18]. Typically, the retina is attached
and the vision is good yet there may be mild chronic irritation/