To reduce the surgical trauma of minimal segmental buckling without drainage even further, in 1979, Lincoff, Hahn, and Kreissig  replaced the segmental sponge sewed onto sclera by a temporary buckle. Subsequently the Lincoff-Kreissig balloon evolved (Fig. 6.9) [37,38]. In contrast to the sponge buckle, (1) the application of the balloon buckle is limited to detachments with one break or a group of breaks within one clock hour, (2) the balloon is not fixated by sutures, and (3) it is withdrawn after 1 week. The rationales for removing the balloon after 1 week were the results of our earlier animal experiments on the strength of the cryosurgical adhesion and the time it takes to develop a sufficiently strong adhesion. Thus, 10 years after the experimental data on the strength of the cryosurgical retinal adhesion were obtained, it was confirmed by the temporary balloon buckle, placed under the break surrounded by cryosurgical lesions and removed after a week. The balloon operation is performed under topical or subconjunctival anesthesia.
No sutures have to be placed to fixate the balloon buckle, and the small conjunctival wound of 1-2 mm needed to insert the balloon catheter will close by itself after withdrawal of the balloon. After that, sustained attachment will depend exclusively on the strength of the retinal adhesion, induced by transconjunctival cryo-pexy prior to insertion of the balloon, or by laser, applied postoperatively, after attachment of the break on the balloon buckle.
The balloon operation represents the ultimate refinement of closing a leaking break ab externo and without leaving a buckle at the wall of the eye. The break is sealed off by surrounding retinal adhesions. It represents a procedure with a minimum of surgical trauma. The balloon operation follows the postulate of Gonin - to find the break and to limit the treatment to the area of the leaking break - and the principle of Custodis - not to drain subretinal fluid. With the balloon, the last complications of segmental buckling, infection or extrusion, and diplopia are eliminated.
Some detachments, which were treated with the temporary balloon buckle, will be depicted:
1. A detachment with a break under a rectus muscle is an optimal indication (Fig. 6.10), since after withdrawal of the balloon, diplopia disappears.
2. A total pseudophakic detachment with an apparent circular anterior traction line (which is, in fact, the vitreous base), capsular remnants, and no certain break (Fig. 6.11). The treatment consists here as well of a temporary balloon buckle in the suspected area to test for the presence of a break; after attachment, the so-called traction line tends to disappear.
Fig. 6.10. Detachment with break under rectus muscle. a Top: The detachment has a break at 9:00 in the area of the rectus muscle. Bottom: With the parabulbar balloon placed in the area of the rectus muscle to tamponade the horseshoe tear at 9:00, the ocular rotations are limited
Fig. 6.10. Detachment with break under rectus muscle. a Top: The detachment has a break at 9:00 in the area of the rectus muscle. Bottom: With the parabulbar balloon placed in the area of the rectus muscle to tamponade the horseshoe tear at 9:00, the ocular rotations are limited b
Fig. 6.11. A total pseudophakic detachment with capsular remnants. a In the detachment in the anterior so-called traction line at 11:30 a little tit was discovered. To find this area of suspicion at the operating table, in the radian of the tit a laser mark was placed in the pars plana prior to surgery. b After balloon operation (1 day): The balloon was inserted beneath the tit at 11:30. The localizing cryopexy lesion is visible on the balloon buckle. The retina is attached. Since a break was not found for certain, it has, however, to be located in the area of the balloon buckle. Therefore, the entire buckle had to be secured with interrupted laser lesions. The lattice degeneration with a pseudohole was not treated, not even at a later time. c After balloon operation at day 9: The balloon was withdrawn, and the entire area of suspicion, formerly placed on the buckle, is covered with pigmented thermal lesions. The retina remained attached during the entire follow-up of 7 years
3. An old detachment with a pigment demarcation line and an intraretinal cyst (Fig. 6.12); here too, a balloon buckle sufficed.
4. The balloon can also be used as a diagnostic tool to test for presence of only one break in two separate detachments (Fig. 6.13).
5. Or, the balloon can be used even in a detachment up for reoperation with PVR stage C2 (Fig. 6.14).
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