180 II: Practice

trauma, (3) mechanical disturbances due to the location and shape of buckling materials, and (4) problems associated with disinsertion or repositioning of a muscle. Factors associated with postoperative muscle imbalance include placement of a buckle beneath a muscle, size of buckling material beneath a muscle, and reoperations.

Therapy for patients with good bilateral vision usually includes an attempt to prescribe prisms to restore fusion. If this is unsuccessful, surgery is considered. Avoiding postoperative muscle imbalance is a major benefit attributed to alternative reattachment procedures.

SUMMARY

Scleral buckling repairs retinal detachments by indenting the sclera under the retinal breaks. Retinal breaks are localized, cryopexy or other thermal treatment is applied to establish a permanent seal around the breaks, and silicone is usually sewn onto the scleral surface. Subretinal fluid may be drained, and gas or fluid may be injected into the eye. Scleral buckling can also be combined with vitrectomy.

Failure to permanently repair the detachment, often with the development of proliferative vitreoretinopathy, is a possible outcome. Potential complications include endophthalmitis, choroidal detachment, increased intraocular pressure, and diplopia.

SELECTED REFERENCES

American Academy of Ophthalmology: The repair of rhegmatogenous retinal detachment. Information Statement. Ophthalmology 1990;97:1562–1572.

Griffith RD, Ryan EA, Hilton GF: Primary retinal detachments without apparent breaks. Am J Ophthalmol 1976;81:420–427.

Hilton, GF, Grizzard WS, Avins LR, et al.: The drainage of subretinal fluid: A randomized controlled clinical trial. Retina 1981;1:271–280.

Lincoff H, Coleman J, Kreissig I, et al.: The perfluorocarbon gases in the treatment of retinal detachment. Ophthalmology 1983;90:546–551.

Lincoff H, Kreissig I: Advantages of radial buckling. Am J Ophthalmol 1975;79:955–957. Michels RG: Scleral buckling methods for rhegmatogenous retinal detachment. Retina

1986;6:1–49.

Norton EWD: Intraocular gas in the management of selected retinal detachments. XXIX Edward Jackson Memorial Lecture. Trans Am Acad Ophthalmol Otolaryngol

1973;77:OP85–98.

Robertson DM: Delayed absorption of subretinal fluid after scleral buckling procedures.

Trans Am Ophthalmol Soc 1978;76:557–583.

Schepens CL, Hartnett ME, Hirose T. Schepens’ Retinal Detachment and Allied Diseases. 2nd Edition. Boston: Butterworth-Heinemann, 2000; pp. 303–324.

Wilkinson CP, Rice TA: Michels Retinal Detachment. St Louis: CV Mosby Co; 1997, pp. 537–594.

Williams GA, Aaberg TM Jr.: Techniques of scleral buckling. In Ryan SJ, Wilkinson CP (eds): Retina. St Louis: CV Mosby Co; 2005; pp. 2035–2070.