A 50-year review of minimal extraocular surgery for retinal detachment: five hurdles had to be overcome for its acceptance

Abstract

The non-drainage segmental buckling procedure by Custodis for repair of a retinal detachment harboured serious postoperative complications. To amend this new technique to a minimal extraocular surgery with practically no intra- nor postoperative complications, four hurdles had to be overcome: diathermy was replaced by cryosurgery, polyviol plombe by the silicone sponge, eight rules were defined to find the break in a primary retinal detachment or in an eye up for reoperation and a subsequent 15-year follow-up of anatomical and functional results confirmed that minimal extraocular surgery for repair of retinal detachment suffices for optimal long-term results without harbouring secondary complications threatening regained visual acuity.

Fig. 1

The four rules to find the primary break in a retinal detachment. From Kreissig [10]

Fig. 2

The four rules to find the missed break in a retinal detachment up for reoperation. From Kreissig [; back cover]

Fig. 3

Minimal segmental buckling without drainage, so-called extraocular minimal surgery: Treatment is limited to area of break and not determined by extent of detachment. The small (top left) and the more extensive detachment (top right) are caused by the same horseshoe tear at 1:00. The treatment of both detachments is the same, consisting of buckling the tear by a segmental sponge, cryosurgery around the break and without drainage of subretinal fluid