Try buckle first!?
Hermann Schubert (New York)
Purpose: To present indications for scleral buckling and retrace its time honored place in the
spectrum of retinal surgery.
Method: Retrospective review of eleven cases of retinal detachment in the author’s practice.
Results: Indications for scleral buckling can arbitrarily be divided into:
1. ideal,
2. slightly less
than ideal,
3. adjunctive or supplemental,
4. prophylactic,
5. by request,
6. extreme.
Whereas ideal indications may include a few small breaks in young phakic individuals (1.),
limited detachments responsive to rest (2.), the encircling buckle adjunctive to vitrectomy (3.)
is most commonly practiced today. Rare indications relate to patients’ expectations and specific
circumstances (4.-6.).
Conclusion: Appropriate individualized treatment of retinal detachments prevents disability.
The method of treatment has to be appropriate for a) the individual type of detachment, b) the individual patient, and c) the
individual doctor. Buckling may be tried first for indications (1.-6., in decreasing order) as well as selected perioperative settings
(a-c).+