Primary Retinal Detachment

Conclusion 49
encircling continue to be popular and are used by a majority of
surgeons. Careful preoperative examination including a detailed
fundus drawing was advocated by Schepens and should still be
done,irrespective of the surgical method.Examination is time consuming
in the age of managed care and even the best effort cannot
always identify all breaks. For the buckling procedure to be successful,
all breaks have to be identified and closed, encircled or not.
Encircling and drainage were successful in 78–96% and have
become synonymous with scleral buckling [15, 37]. Since the 1950s,
at least two generations of surgeons have been well trained in
this procedure. It is “dependable” and incorporates the barrier
concept [2]. Intraoperative localization as to latitude is critical,
but meridional localization may be less precise compared with
minimal radial buckling. The vitreous base is ring-like; supporting
it treats the hidden break and the anticipated traction. Broad buckles
support anterior PVR and circumferential retinotomies [42].
This “ring” concept is behind prophylactic buckling and laser
circling for 360 degrees, as they are meant to barrage and reduce
the incidence of secondary breaks in alternate techniques [14, 16].
Most encircling is reversible: a band can be cut in a timely fashion
without re-detachment or permanent damage from ischemia.
Can the surgeon sleep better after the retina has been drained
flat? It depends: a non-drainage procedure increases the chance
of primary failure, but the eye will survive the attempt almost
intact. By draining, the retina may be attached on the table, yet
morbidity (blood under the macula etc.) may forever preclude
visual recovery. Who could sleep well after the latter? From a
pathologist’s viewpoint, drainage will always be a penetrating injury
to a vascular tissue in an inflammatory and hypotonous
setting. The data reporting intraocular hemorrhage attest to this
simple fact that cannot be changed by even the most sophisticated
technique. The fear of anatomic failure (first operation success or
lack thereof ) apparent to both physician and patient has helped
the propagation of techniques that flatten the retina under the
surgeon’s eye, like external drainage or internal drainage during