Advantages of the Balloon Operation

Advantages of the balloon operation are as follows:

1. The surgery is short, ranging between 10 min and 20 min

2. The anesthesia is topical or subconjunctival

3. The recovery of vision is fast and optimal

4. The last complications of segmental buckling are eliminated, i.e., there is no buckle infection,because the balloon is removed, and no diplopia. Diplopia, if present, disappears after the balloon is withdrawn.

Fig. 6.12. Old inferior detachment. a The detachment has several pigment demarcation lines, an intraretinal cyst, and a round hole at 5:30. b After balloon operation at day 9: After balloon insertion (1 day) the retina had attached. After pigmentation of the cryopexy lesions around the break, the balloon was withdrawn after a week. There are still visible the pigment demarcation lines and the intraretinal cyst

Fig. 6.12. Old inferior detachment. a The detachment has several pigment demarcation lines, an intraretinal cyst, and a round hole at 5:30. b After balloon operation at day 9: After balloon insertion (1 day) the retina had attached. After pigmentation of the cryopexy lesions around the break, the balloon was withdrawn after a week. There are still visible the pigment demarcation lines and the intraretinal cyst

Fig. 6.13. Two separate detachments with only one questionable break. a There is a superior detachment with two lattice degenerations and "erosions". A most likely break is located at 11:00 with obvious vitreous traction at the lateral edge of lattice degeneration. The convex pigment demarcation line beneath the superior detachment posterior to the lattice degeneration indicates that a full thickness break might be present at 11:00. In the inferior detachment, there is a questionable tear at 8:00 at the lateral edge of lattice degeneration. When lying the patient flat, no communication between the two separate detachments was detected. b After insertion of a diagnostic balloon (1 day) beneath the suspected break at 11:00: The break and the entire lattice is surrounded with cryopexy lesions. The superior retina had attached and the inferior detachment diminished in size, indicating that its fluid is originating from the superior break now being tamponaded. c After balloon operation (10 days): The balloon was withdrawn after 8 days when the cryopexy lesions were pigmented. The lattice degeneration at 12:00 was surrounded with laser lesions. There is still residual fluid around the inferior lattice degenerations. d After balloon operation (4 weeks): The residual fluid had disappeared. No further treatment was added

Fig. 6.i4a,b. Legend see page 124
Fig. 6.14c

Fig. 6.14. Balloon as late reoperation of proliferative vitreoretinopathy (PVR)-C2 detachment. a A three-quadrant detachment with PVR and starfolds in two quadrants in an eye with a previous buckle operation with diathermy and a tear anterior to the buckle at 9:00. As minimal approach for reoperation in presence of diathermized sclera, a parabulbar balloon was selected. b After balloon operation (6 months): The macula had already attached 2 days after surgery. At 6 months, a residual traction detachment with concave contours and concave surface is persisting; the macula is still attached. c After balloon operation (4 years): The traction detachment has flattened, only faint remnants of starfolds are visible

All of the listed advantages can be achieved by applying a temporary and not suture-fixated balloon buckle without drainage as treatment for a primary retinal detachment. But the "conditio sine qua non" for success with this minimal procedure is experience in the non-drainage operation. The surgeon has to be an expert in indirect binocular ophthalmoscopy and has to be able to locate a balloon correctly in the parabulbar space beneath a highly detached break.

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