1. PRINCIPLES OF RETINAL DETACHMENT SURGERY
1. Scleral buckling
Configuration of buckles
Preliminary steps
Localization of breaks
Cryotherapy
Insertion of local explant
Encircling procedure
Drainage of subretinal fluid
Causes of early failure
2. Pneumatic retinopexy
3. Vitrectomy
Giant tears
Proliferative vitreoretinopathy (PVR)
Diabetic tractional RD

2. Configuration of scleral buckles
Segmental
circumferential
Radial
Encircling
augmented by radial
sponge
Encircling
augmented by solid
silicone tyre

3. Preliminary steps Peritomy Insertion of squint hook under
rectus muscle
Inspection of sclera for thinning
or anomalous vortex veins
Insertion of bridle suture

4. Localization of breaks
Insert 5/0 Dacron scleral suture
at site of apex of break
Grasp cut suture with curved mosquito
forceps close to knot
While viewing with indirect
ophthalmoscope check position of
indentation in relation to break

5. Cryotherapy While viewing with indirect ophthalmoscope
indent sclera gently with tip of cryoprobe
Freeze break until sensory retina just
turns white

6. Insertion of local explant
Distance separating sutures
measured and marked
Insertion of mattress-type suture
Sutures tightened over explant
Ends trimmed

7. Encircling procedure Strap fed under four recti
Ends secured with Watzke sleeve
Strap slid posteriorly and secured
in each quadrant
Strap tightened to produce required
amount of internal indentation

8. Drainage of subretinal fluid
Indications
Difficulty in localizing break
Immobile retina
Longstanding RD
Inferior RD
Technique
Complications
Haemorrhage
Retinal incarceration

9. Causes of early failure
Buckle failure
Buckle inadequate
size or height
Buckle incorrectly
positioned
‘ Fishmouthing ’ of retinal tear
May be associated
with communicating
radial retinal fold
Insert additional radial
buckle

10. Pneumatic retinopexy Indications Technique RD with superior breaks
(a) Cryotherapy
(b) Gas injection
(c) Postoperative positioning
(d) Flat retina

11. Vitrectomy for giant tears
Unrolling of flap with light
pipe and probe
Completion of unrolling
Injection of silicone oil or
heavy liquid

12. Vitrectomy for PVR Dissection of star folds and peeling of membranes
Injection of expanding gas or silicone oil

13. Vitrectomy for diabetic tractional RD
Release of antero-
posterior traction
Release of circumferential
traction
Endophotocoagulation