| Circumferential Buckling on Equator: I. Rationale of Circumferential Buckling on Equator with Conserved Scleral Implant. |
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Sang Ha Kim |
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Department of Ophthalmology, School of Medicine University of Kyung-Book, Korea. |
| 안구적도상에 시술하는 위도공막돌융술식 (緯度鞏膜突隆術式) - Ⅰ. 보존공막을 Implant 로 사용한 적도상 위도공막돌융술식의 (緯度鞏膜突隆術式) 원리 |
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김상하 ( Sang Ha Kim ) |
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| Abstract |
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Circumferential orientation of the buckle in desirable length may be preferable for closing the retinal breaks and the neighboring retinal degenerations. In contrast to radial buckling, according to Lincoff et al, the circumferential one is likely to lead to fishmouthing and radial folds; and the greater the buckle length, the more radial folds are anticipated. In this paper I summarized my opinions on these two problems pertaining to circumferential buckling; the method for preventing fishmouthing and diminishing radial folds on which the hole would impinge and leak posteriorly. A lamellar scleral undermining is performed on both sides of a single scleral incision which is parallel to the limbus and lccated on the equator. The undermining extends from the ora serrata to the region near the scleral entrance of the vortex veins (Fig. 2). The vortex veins are left intact. Surface diathermies are applied in the area undermined. Multiple penetrating diathermies are then applied in the undermined area near the retinal breaks to release subretinal fluid so that the detached retina of the breaks' area may sink on to the pigment epitheHum at first. Preserved sclera is used as an implant. The surface of the implant remains irregulary contoured. The width and the height of the implant depend upon the buckle desired (Fig. 1). After the implant is in place, the sutures are first tied in an area near the retinal breaks so that the radial folds move laterally from the retinal breaks. The surface of the buckles is somewhat irregular, which may compensate for redundant limbal parallel circumference of the detached retina (Fig. 3). The operation may be segmental or encircling. The circling band follows the globe's equator. 17 cases of ratinal detachments were treated with this technique; and in none of the above cases did the posterior edge of the break fishmouth or impinge upon a radial fold. The 100 percent final success in the small series of 17 cases in which an equatorial buckling was used at the initial surgery is also attributable to the relative lack of compiexity (excluding dialysis, giant tears, fixed retinal folds etc.) of cases. In my opinion, circumferential buckling on the equator utilizing a preserved sclera as an implant is convenient, sufficiently promising and carries less risk of reoperation. |
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