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A Medline search was made of all reports that were identified by the search terms "retinal detachment," "segmental buckling," "minimal extraocular surgery," and "nondrainage." Reports published in English, German, Italian, French, Spanish, and in some East European journals were reviewed and analyzed. The majority of reports did not contain homogenous data suitable for the analysis. Many included both complicated and uncomplicated detachments, primary detachments and reoperations, or no preoperative characteristics. In many series, primary segmental buckling was combined with a cerclage. The buckling was performed with or without drainage of subretinal fluid. Primary segmental buckling was sometimes combined with an injection of air, an expanding gas, or silicone oil.

After excluding these reports, an analysis was made of a relatively homogenous series of mostly primary retinal detachments, some with preoperative PVR stage C1-C2. The primary procedure in all eyes was minimal segmental buckling without drainage of subretinal fluid. The analysis consists of five reported series with a combined total of 1,462 retinal detachments [26,37,39-42].

The preoperative characteristics of the 1,462 primary retinal detachments were: aphakia/pseudophakia in 8.3% and preoperative PVR stage C1-C2 in 2.9% (Table 6.i).All operations were done under local anesthesia. Coagulation was limited to the area of the break(s) and performed with intraoperative cryopexy under ophthalmoscopic control or with laser coagulation on a subsequent day after the break was attached. The buckle was limited to the area of the break(s) and was obtained with an elastic silicone sponge or a temporary balloon. Subretinal fluid was not drained in any eye. Some of the detachments treated are represented in Figs. 6.4-6.13, recruited from series 2 and 5. All patients were mobilized after

Table 6.1. Preoperative characteristics of 1,462 primary retinal detachments treated with minimal segmental buckling (sponges or balloons) without drainage

Series

Detach

Aphakia

Perforating

Reoperation

Proliferative

Myopia

ment

pseudo-

injury

vitreoretino-

phakia

pathy stage

Ci C2

> -7 to -25 dpt

First [21,39]

752

30

_

7

5

n.a.a

Second [26,40]

107

22

-

-

12 4

9

Third [41]

35

3

-

-

51

5

Fourth [42]

68

5

1

-

11 -

5

Fifth [37]b

500

62

3

30

32

71

122 (8.3%)

43 (2.9%)

a Not available b Treated with balloon surgery. The temporary balloon buckle was deflated and removed after 1 week.

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