Lincoff H, Kreissig I
Department of Ophthalmology, New York Hospital-Cornell Medical Center, New York, USA.
Ophthalmology. 1996 Oct;103(10):1586-92. doi: 10.1016/s0161-6420(96)30459-4.
After a failed buckle surgery, the second procedure tends to be a gas injection and the third a vitrectomy.
The failures from two series, consisting of 752 and 500 buckle surgeries, were analyzed for cause, solution, and outcome after repeat surgery with a segmental or encircling buckle.
The most frequent cause of failure was an undetected break. An analysis of the postoperative contour of the detachment suggested its presence and helped to locate it. Failure occurred nearly as frequently because the buckle was inadequate. It was poorly placed, too narrow, or too shallow. An undetected break or an inadequate buckle was the cause of 73% of the failures in the first series and 79% of failures in the second series. The failure from either cause responded, with few exceptions, to a segmental explant.
The arbitrary sequence of intraocular gas and then vitrectomy in response to failure to attach the retina with a scleral buckle often is misdirected.
巩膜扣带术失败后，二次手术往往是气体注入，第三次手术是玻璃体切除术。
对两个系列分别包含752例和500例巩膜扣带术的失败病例进行分析，以确定再次行节段性或环形巩膜扣带术的原因、解决方案及结果。
最常见的失败原因是未检测到的视网膜裂孔。对脱离术后轮廓的分析提示裂孔的存在并有助于定位。因巩膜扣带不足导致失败的情况几乎同样常见。扣带位置不佳、过窄或过浅。在第一个系列中，73%的失败是由未检测到的裂孔或巩膜扣带不足引起的，在第二个系列中这一比例为79%。除少数例外，由这两种原因导致的失败对节段性外植片均有反应。
因巩膜扣带未能使视网膜复位而先后进行眼内气体注入和玻璃体切除术的随意顺序往往是错误引导的。
