Disadvantages of Primary Minimal Segmental Buckling Without Drainage

Disadvantages of primary minimal segmental buckling without drainage are as follows:

1. Preparation for a minimal buckle operation, limited to the break and without drainage, requires extensive preoperative study. When a retinal break is not obvious, intensive biomicro-scopic study of the peripheral retina can be time-consuming, but is necessary.

2. A prerequisite for minimal segmental buckling without drainage is having experience in indirect ophthalmoscopy and bio-microscopy to be able to find all of the breaks.

3. Experience with the special guidelines (the 8 Rules) and indirect wide-field contact lenses can help the biomicroscopic search for small breaks in a pseudophakic eye [19,20-22,51].

4. There is a learning curve to localizing posterior breaks in a bullous detachment and buckling them adequately without drainage of subretinal fluid.

5. If a radial sponge is placed in the area of a rectus muscle, diplopia may occur. But diplopia can be averted with the use of a temporary balloon for breaks located beneath a rectus muscle.

6. Exposure or infection of the sponge buckle can occur, but is infrequent and ranges at <0.5%. After removal of the sponge, redetachment is rare, if a week or more has elapsed and the coagulation-induced adhesions have matured. In some cases, supplemental laser around the break may be applied prior to removal of the buckle.

7. The concept of minimal buckling without drainage can be difficult to accept because the retina is not attached at the operating table. Instead, the surgeon must wait for 24 hours or more for the retina to attach spontaneously. This may be a strain on the surgeon and "disturb his sleep," as often described. However, postoperative spontaneous attachment is an absolute confirmation that the operation was correct.

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