Why Was Acceptance of the Cryosurgical Operation Delayed

There were doubts that limited its acceptance:

1. Was the cryosurgical adhesion strong enough? This was eventually confirmed by extensive animal experiments by Kreissig and Lincoff [17,18]. It was proved that cryopexy induces a sufficiently strong adhesion in 5 days and reaches maximum strength after 12 days.

2. Would this spontaneous or "magical" disappearance of subreti-nal fluid occur by tamponading the leaking break ab externo with an elastic buckle, even if the break is still detached over the buckle at the end of surgery? This was the most difficult issue to accept. Why? Because in this situation, the surgeon has to leave the operating table with the retina still detached, in contrast to the one after drainage or the injection of a gas bubble after drainage, in which case the retina is already attached at the table. Following such an operation, the surgeon can feel relaxed and, as often said,"sleep better." However, the secrets of success with nondrainage are: first, the surgeon has to be convinced that all of the breaks have been found and tamponaded sufficiently, and, second, a spontaneous attachment on the next day will confirm that all of the breaks were found and tamponaded sufficiently. However, this will be the case only in retrospect, i.e., hours after surgery combined with postoperative concern on the part of the surgeon. However,by performing drainage, often explained as being done for the sake of the surgeon or the patient, the retina might be attached at the table only temporarily, due to the drainage alone.

As a consequence, the "conditio sine qua non" for spontaneous attachment after nondrainage is that all of the leaking breaks have been found and tamponaded sufficiently intraoperatively. Otherwise, the spontaneous or "magic" disappearance of subretinal fluid will not occur. Other questions were:

3. Will a buckle that is unsupported by an encircling band persist?

4. Is the prophylactic value of a cerclage needed for long-term retinal attachment?

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