Primary Retinal Detachment

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3 Encircling Operation with Drainage for Primary Retinal Detachment
It is of note that two of the series [15, 37] compared scleral buckling
(78–100% encircling and 72–85% drainage) to pneumatic
retinopexy. Scleral buckling was therefore used synonymously
with encircling and drainage in the recent literature and we can assume
that it represents the standard of care.
Encircling at Wills Eye Hospital in 1985
To test this hypothesis, that encircling and drainage are still the
primary procedure, the author reviewed 100 consecutive scleral
buckling procedures done at Wills Eye Hospital from 1985 to 1986.
Eleven members of the retina service encircled primary detachments
in 83% and drained in 73% of cases, consistent with the
literature.
Air or gas was injected in 6%. The extent of the detachment was
one quadrant in 10%, two quadrants in 52%, three quadrants in 21%
and four quadrants in 17%. The average area of detachment was 2.9
quadrants.
The preferred buckling procedure consisted of a 3-mm encircling
band used in 83%, combined with a 7-mm explant which was
used in 73%. The explant covered 2.3 quadrants on average so that
in 49% of all cases it covered the entire extent of the detachment
(Fig. 3.6). The primary success rate was around 90%. The author
had no follow-up after discharge from the hospital, except for
re-admissions.
It is easy to see why this skillfully executed procedure had a high
success rate. Careful preoperative study was mandatory as was a
detailed retinal drawing. (Encircling and drainage did not mean
that the study of the retina was optional). Patients were admitted
the day before surgery, were studied in the evening and stayed
overnight to help flatten the detachment. During surgery, all breaks
were carefully marked on sclera to ensure their placement on the
crest or anterior slope of the buckle. Cryopexy was applied to
breaks, lattice and suspicious retinal lesions. Since the majority of