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Controversies |

The Declining Use of Scleral Buckling With Vitrectomy for Primary Retinal Detachments

Deborah Y. Chong, MD; Dwain G. Fuller, MD, JD
Arch Ophthalmol. 2010;128(9):1206-1207. doi:10.1001/archophthalmol.2010.190.
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The evolution of pars plana vitrectomy (PPV) as a primary technique for the repair of rhegmatogenous retinal detachment (RD) without concomitant scleral buckling (SB) suggests that physician perception and patient preferences may be changing. We argue that PPV alone may lead to successful surgical outcomes in many instances.

Dating back to the description of scleral resection by Müller in 1903,1 various forms of altering the globe wall to bring the choroid toward the retina have been used in retinal reattachment procedures. The revolutionary hypothesis of Jules Gonin in 1918 that retinal breaks caused by vitreous traction constitute the pathogenic mechanism in retinal detachments2 laid the groundwork for developing various ingenuous ways to release vitreous traction by creating scleral indentation. These techniques include the use of polyethylene tubes, sutures, gelatin, human sclera, fascia lata, and plantaris tendon. In 1949, Custodis3 performed the first SB with an exoplant and ushered in the modern era of SB that has continued to the present.

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