Extraocular repeat surgery of retinal detachment : A minimal approach

After a failed buckle surgery, the second procedure tends to be a gas injection and the third a vitrectomy. The failures from two series, consisting of 752 and 500 buckle surgeries, were analyzed for cause, solution, and outcome after repeat surgery with a segmental or encircling buckle. The most frequent cause of failure was an undetected break. An analysis of the postoperative contour of the detachment suggested its presence and helped to locate it. Failure occurred nearly as frequently because the buckle was inadequate. It was poorly placed, too narrow, or too shallow. An undetected break or an inadequate buckle was the cause of 73% of the failures in the first series and 79% of failures in the second series. The failure from either cause responded, with few exceptions, to a segmental explant. The arbitrary sequence of intraocular gas and then vitrectomy in response to failure to attach the retina with a scleral buckle often is misdirected.