Preparation for a segmental buckle operation can require much study time, frequently hours and sometimes days. A decade ago, if the senior author (HL) could not find a break that promised a 90% prognosis after an hour's study, he would patch both eyes, put the patient at rest, and re-study the eye the next day. Most detachments change with ocular rest, and the change is informative. Today, the insurance companies and Medicare do not allow for an extra day, nor is there payment for study time. It is more expedient to do a vitrectomy and search for the retinal break at the operating table, where the wage rate is 37% higher (Medicare fees from New York, New Jersey, Connecticut). If one does not find the break, a surgeon might be inclined to do a peripheral laser barricade augmented by an encircling band. The barrier operation, which was disappearing near the end of the twentieth century, is returning as a prophylactic supplement to primary vitrectomy and pneumatic retinopexy .
Was this article helpful?