Specifics

This surgery is derived from the cryosurgical detachment operation of Lincoff, introduced in 1965 [16], which brought about two major changes: (1) the change from intraocular to extraocular surgery, since drainage of subretinal fluid was omitted and (2) the change from a surgery of the detachment to a surgery of the retinal break. The retinal break represented the only issue of the new surgery.

In subsequent years, the preconditions for this specific break surgery were further improved by better fundus examination techniques: binocular indirect ophthalmoscopy, as developed by Schepens, biomicroscopy, as introduced by Goldmann, development of various direct and indirect contact lenses, the 4 Rules for finding the primary break [19,20], and the subsequent 4 Rules for finding a missed break in an eye requiring reoperation [21, 22]. Today, these 8 Rules represent essential guidelines for the detection of the leaking break in a detachment, which is the precondition for surgery limited to the area of the break. By performing this kind of a minimal extraocular surgery, the time required for a retinal detachment operation became dramatically reduced; however, the time needed for preoperative study increased.

If retinal attachment did not result within days following surgery, the logical questions had to be: (1) Has a break been overlooked? (2) Is the break that was buckled still leaking due to an inadequate tamponade? Both causes of failure are iatrogenic. Thus, one can understand why an operation that would provide retinal attachment on the table and additional prophylaxis for overlooked breaks by encircling might be preferred by some surgeons.

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