Purpose: To prove the role of the vitreous in retinal detachment surgery with scleral buckling procedures, we retrospectively investigated the charts of patients who were operated on for retinal detachment by scleral buckling between January 1995 and June 1997. Methods: Out of a total of 718 cases, 41 retinal detachments occurred in previously vitrectomized eyes. The buckling procedure consisted of silicone sponge explants in 513 cases (254 radial, 259 circumferential) and of encircling elements in 202 cases. Three eyes received a temporary balloon. The minimal follow-up was 3 months. Results: After primary surgery in the 677 nonvitrectomized eyes, the retina was attached in 482 eyes (71.2%), after reoperation in 627 eyes (92.6%). With up to 3 reoperations (including vitrectomy with gas or silicone oil tamponade in 79 eyes), the final success rate was 98.7%. The corresponding reattachment rates in the 41 vitrectomized eyes were 82.9% after primary surgery and 97.6% after reoperation. Repeated surgery in 6 eyes consisted of successful internal tamponade by silicone oil. The reattachment rates after primary buckle procedure are of most interest to the role of the vitreous: the highest success rate (82.9%) was achieved in the vitrectomized eyes versus 71.2% in the nonvitrectomized eyes. The difference is statistically not significant. Conclusions: We therefore conclude that the absence of the vitreous has no adverse effect on the results of buckling procedures for retinal detachment. The choice of the surgical technique in treating retinal detachments in vitrectomized eyes should only determined by retinal findings such as the number and extent of breaks or the presence and stage of proliferative vitreoretinopathy.

Keywords:
Pars plana vitrectomy, Buckling surgery, Vitreous
1.
Banker AS, Freeman WR, Kim JW, Munguia D, Azen SP: Vision-threatening complications of surgery for full-thickness macular holes. Ophthalmology 1997;104:1442–1452.
2.
Custodis E: Bedeutet die Plombenaufnähung auf die Sklera einen Fortschritt in der Behandlung der Netzhautablösung? Ber Dtsch Ophthalmol Ges 1953;58:102–105.
3.
Lincoff HA, Baras J, McLean J: Modification of the Custodis procedure for retinal detachment. Arch Ophthalmol 1965;73:160–163.
4.
Lincoff HA, McLean JM: Modification of the Custodis procedure. II. A new silicon implant for large tears. Am J Ophthalmol 1967;64:877–879.
5.
Kreissig I, Rose D, Jost B: Minimized surgery for retinal detachment with segmental buckling and nondrainage. Retina 1992;12:224–231.
6.
Machemer R: The importance of fluid absorption, traction, intraocular currents, and chorioretinal scars in the therapy of rhegmatogenous retinal detachment. Am J Ophthalmol 1984;98:681–693.
7.
Clemens S, Kroll P, Stein E, Wagner W, Wriggers P: Experimental studies on the disappearance of subretinal fluid after episcleral buckling procedures without drainage. Graefe’s Arch Clin Exp Ophthalmol 1987;225:16–18.
8.
Klöti R: Die Bedeutung vitreo-retinaler Beziehungen für die Pathogenese and Therapie der Amotio retinae; Doden W (ed): Amotio retinae. Bücherei des Augenarztes. Stuttgart, Enke, 1970, vol 53, pp 765–93.
9.
Gerke E, Meyer-Schwickerath G, Siebert A: Healon® bei Netzhautablösung; in Meyer-Schickerath G (ed): Viskochirurgie des Auges. Stuttgart, Enke, 1984, pp 99–103.
10.
Foulds WS: Do we need a retinal pigment epithelium (or choroid) for the maintenance of retinal apposition? Br J Ophthalmol 1985;69:237–239.
11.
Kirchhof B, Orr G, Ryan SJ, Lean JS: The role of the vitreous and the retina in controlling the transfer of tritiated water from the vitreous cavity to the choroid. ARVO, Sarasota 1986. Invest Ophthalmol Vis Sci 1986;27(suppl): 316.
12.
Thompson JT: Mechanism of action and physical effects of scleral buckles on the retina and adjacent tissue; in Ryan SJ (ed): Retina. St Louis, Mosby, 1989, vol 3, pp 151–163.
13.
Michels RG, Wilkinson CHP, Rice THA: Retinal Detachment. St Louis, Mosby, 1990.
14.
Kreissig I, Simader E, Rose D: Die Rolle der segmentalen Plomben-Chirurgie in der Behandlung der PVR-Ablatio Stadium B and C. Klin Monatsbl Augenheilk 1994;205:336–343.
15.
Lincoff HA, Kreissig I: Die Behandlung der Netzhautablösung ohne Drainage der subretinalen Flüssigkeit. Klin Monatsbl Augenheilkd 1973;162:160–170.
16.
Hilton GF, Grizzard WS, Avins LR, Heilbron DC: The drainage of subretinal fluid: A randomized controlled clinical trial. Retina 1981;1:271–280.
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2002
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