[Detachment surgery without drainage (author's transl)].

Abstract

Detachment surgery without drainage was introduced in 1953 by Custodis and modified by Lincoff. In this method the retinal hole determines the surgical procedure. Subretinal fluid will disappear by fixating an explant the sclera under tension in the area of the hole. The size of the explant depends upon the size of the retinal hole. Radial orientation of the buckle proves to be an optimal tamponade for a horseshoe tear. The change from traditional extensive circumferential buckles and cerclages to radial orientation of the buckle in the area of the hole is to be considered as a logical evolution in detachment surgery. From 1970--1977 there were treated 1000 consecutive detachments with cryopexy and elastic episcleral sponges. Non drainage was done in 93% of the time. The extension of the detachments ranged in 84% of the time from over 1 to 4 quadrants. The surgical procedure, however, consisted in 96% of the cases in segmental buckles with a preference for radial orientation. Cerclage was found to be useful in 4% of the time; an aphakic detachment was no longer an indication per se for an encircling procedure. Reattachment occured in 83% of the cases after one operation and in an additional 8% after reoperation. The complications with this procedure were minor, extraocular and reversibel. In 2,7% of the time an infection was observed around the explant. After removal of the buckles infection disappeared in every eye, re-detachment did occur in none of the eyes.