Origins of Encircling Arruga and Schepens

Arruga devised a simple procedure using a nylon, silk or supramid suture to encircle the equator of the eye (Fig. 3.1). Breaks were either diathermized according to Gonin's principle or isolated by a barrier: "Je diathermise la region des dechirures, ou aux endroits qu'il faut isoler par un barrage" [1].

Arruga's operation consisted of a treatment of breaks, creation of barriers, and volume reduction. Fluid was drained from and air was injected into the eye to replace lost volume. Tying a suture at the equator (14 mm posterior to the limbus) both reduced the volume of the ocular cavity, relieving vitreous traction, and protected the posterior segment from the torn anterior segment, at the price

Fig. 3.1. An Arruga suture was placed 14 mm posterior to the limbus to protect the posterior segment from the "porous" anterior retina of constriction. Constriction could lead to intrusion of the suture into the eye and narrowing of the lid fissure [9], but more often it would lead to ocular ischemic symptoms: lid edema, chemosis, uveitis and ocular hypotension, also described as the "string syndrome" [10].

At about the same time, Schepens recognized the imperfect location of an equatorial circling suture, which walled off anterior breaks without really buckling or closing them. He wrote that "Such a barrage forms a dyke, which limits the detachment to the area surrounding the untreated retinal breaks and protects the portion of the retina which has potential usefulness" [2]. The location (latitude) of the circling polyethylene tube was determined by the posterior edge of the most posterior retinal break. Ideally, all breaks of similar latitude would come to lie on the anterior slope or the crest itself, which would follow as closely as possible "the great circle of the eyeball" [2].

sign", meridional folds and the barrier function which is incomplete in-feriorly of the 2.5-mm band. The eye was uncomfortable with signs of iritis as part of the "string syndrome"

Breaks posterior to the crest would lead to failure, whereas those too far anterior to be buckled could be walled off by diathermy barriers. After drainage, the encircling band was shortened up to 25-30 mm in severe cases of massive vitreous retraction. Since the retinal circumference at the equator measures 72 mm in the emmetrope, such reduction was 40%, complicated by meridional folds or fishmouthing of the horseshoe tear(s) and subsequent redundant folds across the crest of the buckle (Fig. 3.2).

The 1957 encircling operation closed breaks in the chosen latitude and walled off anterior breaks, but it did not reliably support the anterior horns of horseshoe tears [11,12]. Anterior buckling was improved by the addition of myriad shapes of wider explants, including "accessories", "radial wedges" and "meridionals," which are still available commercially today [13].

Was this article helpful?

0 0

Post a comment