Encirclement versus 360 degrees buckling and prognostic factors in retinal separation surgery

In 554 consecutive primary cases, adverse prognostic factors for successful retinal detachment surgery were aphakic retinal detachment, severe vitreous traction creating retinal breaks, especially with lattice degeneration, long-standing retinal separations, choroidal or combined detachments, giant tears, Marfan's syndrome, and preoperative massive vitreous retraction (MVR). Vitreous haemorrhage was of secondary importance, and not a primary cause of MVR. The use of therapeutic encirclement is unnecessary and does not prevent the proliferative process of MVR. The few indications for cerclage, such as total retinal separation with no detectable breaks, total retinal separation with breaks in all quadrants, and MVR, are more effectively treated by 360 degrees scleral buckling. Encirclement should not be used as a constriction to obtain a buckle or to compensate for lost intraocular volume after drainage of subretinal fluid.