[Scleral buckling surgery and pneumatic retinopexy. Techniques, indications and results]

For many decades, conventional buckling surgery has been the gold standard for treating rhegmatogenous retinal detachment. The surgical technique has not changed markedly during this period; the three main buckling techniques currently used are the radial sponge, segmental sponge, and encircling band. With one of these options, an anatomic success rate of over 90% can be achieved in "simple" forms of retinal detachment. In pseudophakic eyes, however, the primary reattachment rate after buckling procedures is lower. Pneumatic retinopexy, because of its lower success rate, has not found general acceptance in Europe and is used only in selected cases. Concerning the results of the SPR study, many vitreoretinal surgeons were surprised that in the subgroup of phakic eyes, scleral buckling surgery achieved a comparable reattachment rate and better functional results even in this group of patients with complex hole configuration. This gives physicians reason to critically question the current trend of primary vitrectomy even in eyes with uncomplicated preoperative pathology and to reassess scleral buckling surgery. The longer learning curve to perform buckling surgery should be accepted. Because successful repair depends on careful preoperative examination, thorough training in binocular ophthalmoscopy skills with scleral depression should remain an essential part of the surgeon's education.