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

Fig. 3.6. Example of routine encircling and drainage: The eye was buckled with a 7-mm explant for the entire extent of the detachment. Drainage was made near a rectus muscle in the bed of the buckle. A 2.5-mm band was used to encircle the eye to barricade undetected breaks

breaks were located at a latitude 13-14 mm posterior to the lim-bus, detected, undetected and anticipated future breaks would be covered.

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