[Principles of treatment of detachment using minimal retinal surgery]

Abstract

Minimization of detachment surgery became feasible by: (1) omitting drainage of subretinal fluid by using elastic plombages limited to the area of the break and (2) meticulous search for the retinal break(s). On this premise the extent of the operation is solely determined by the size of the break(s) and no longer by the extent of the detachment. There were conceived: (1) the cryosurgical detachment operation in treating detachments with several breaks by single sponges (radial buckles whenever possible) by being permanent plombages and (2) the balloon operation in treating detachments with a single break by using a temporary plombage. These operations, being extraocular, can be applied in more than 9 of 10 rhegmatogenous detachments and the retina will be reattached in more than 9 of 10 cases. -However, in the presence of a problematic break (giant tear, posterior hole) an intraocular operation by using expanding gases (SF6, Perfluorocarbons) is indicated: (3) the expanding gas operation and (4) the balloon-gas procedure. By using the balloon-gas procedure (reducing the number of gas injections for treating a giant tear to one injection by providing a sufficiently large gas plombage) and (5) the modified balloon-gas operation with a retrohyaloidal injection of gas instead, a decrease of vitreoretinal complications, otherwise the main cause of failure, seems apparent.