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Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001

.pdf

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28.03.2026

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Configuration of scleral buckles

	Radial	Segmental
	Radial	circumferential
		circumferential

	Encircling	Encircling
		augmented by radial
	augmented by solid
		sponge
	silicone tyre

Preliminary steps

Peritomy	Insertion of squint hook under
	rectus muscle

	Insertion of bridle suture	Inspection of sclera for thinning
	Insertion of bridle suture	or anomalous vortex veins
		or anomalous vortex veins

Localization of breaks


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

Cryotherapy

While viewing with indirect ophthalmoscope indent sclera gently with tip of cryoprobe

Freeze break until sensory retina just turns white

Insertion of local explant

Distance separating sutures	Insertion of mattress-type suture
measured and marked

Sutures tightened over explant

Ends trimmed

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

Drainage of subretinal fluid

Indications

•Difficulty in localizing break

•Immobile retina

•Longstanding RD

•Inferior RD

Technique

Complications


Haemorrhage	Retinal incarceration

Causes of early failure

Buckle failure

	Buckle inadequate	Buckle incorrectly
	size or height	Buckle incorrectly
	size or height	positioned
		positioned

‘ Fishmouthing ’ of retinal tear

May be associated	Insert additional radial
with communicating	buckle
radial retinal fold

Pneumatic retinopexy

Indications

RD with superior breaks

Technique

(a)Cryotherapy

(b)Gas injection

(c)Postoperative positioning

(d)Flat retina

Vitrectomy for giant tears


Unrolling of flap with light	Completion of unrolling	Injection of silicone oil or
pipe and probe		heavy liquid

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