[Failures in primary surgery of retinal detachment with cerclage]

In a retrospective study we analysed 30 unsuccessful circumferential buckling operations being performed in the years 1990 and 1991 as primary interventions on simple retinal detachments without PVR, directing our attention to the cause of the failure. 13 eyes (43%) showed simple retinal detachments with holes located anterior (20%) or posterior (23%) to the circumferential buckle. In 12 of these eyes (40%) the retina could be reattached permanently by a re-operation with a second scleral buckling procedure. Another 15 eyes (50%) showed retinal holes not being sealed by the circumferential buckle. In addition, however, the retina in these eyes was kept from reattachment by a PVR grade C or D at the time of the re-operation. In 9 eyes (30%) of this group reattachment could be achieved after vitrectomy with endotamponade, in 6 eyes (20%) the retina could not be reattached. Only 2 eyes (7% of all patients) showed a PVR detachment without detectable retinal breaks. Thus, failures of primary circumferential buckling operations in numerous cases are caused by either inadequate surgical procedures or by a poor surgical technique.