External buckling without drainage for selected detachments in aphakic eyes

Of 325 patients with retinal detachments, 110 patients (34%) had aphakic eyes. These detachments were subdivided into three types based on their clinical appearance during indirect ophthalmoscopy and slit-lamp biomicroscopy. Fifty-two patients (47%) had aphakic detachments (Type 3), categorized by small tears due to traction along a prominent posterior or vitreous base and the absence of visible retinal degeneration. Fifty of the 52 patients in this group were operated on by using a modification of the nondrainage procedure developed by Custodis, and employing cryosurgical coagulation and an external encircling buckle using a 3-mm silicone sponge. The sponge was secured beneath the retinal tear, and its length was shortened to produce a moderately elevated buckle. Although 50% of retinal tears were open at the end of the operation, 60% of all eyes operated on without drainage reattached in 16 hours, 90% in one week, and the remainder in two weeks. Visual acuity of 70% of these patients was 6/15 (20/50) or better when tested six months after surgery. The operation did not wall away peripheral fluid, but closed retinal tears completely, reduced circumferential vitreous traction, and avoided drainage of subretinal fluid.