Mortada A
Ophthalmologica. 1977;175(3):143-7. doi: 10.1159/000308646.
(1) In operable giant tear extending slightly behind the equator, the oblique encircling silastic 3 mm band without evacuation of subretinal fluid gave a 70% success rate. In 30% of the cases a small most posterior part of the tear was seen unclosed behind the band effect. This was because of thick sclera opposite the tear area preventing proper buckling. (2) This gave an occasion to see during reoperation the effect of segmental silastic 5 mm rod buckling opposite the unclosed part of the tear. (a) Two rods placed radially between the band and the sclera opened the whole giant tear again. (b) One rod placed circumferentially behind the band succeeded in closing the unclosed part of the tear. (3) To have a sufficient wide buckle in cases of thick sclera opposite giant tears one of the best, safest and easiest solutions is to weaken the sclera behind the tear by incising about half scleral thickness opposite the anterior and posterior margins of the oblique band (or even lamellar scleral resection underneath the oblique band) in a wider area than the tear meridans extent (Mortada modified operation). This helps buckling at a lower band tightness, thus avoiding any complication of pressure uveopathy.
(1) 在可手术治疗的、赤道后稍远处延伸的巨大裂孔病例中，采用不排出视网膜下液的3毫米斜向环形硅橡胶带，成功率为70%。在30%的病例中，在带的作用后方可见一小部分最靠后的裂孔未闭合。这是因为裂孔区域相对的巩膜增厚，妨碍了适当的扣带。(2) 这为再次手术时观察5毫米节段性硅橡胶棒在裂孔未闭合部分相对处扣带的效果提供了契机。(a) 在带与巩膜之间径向放置两根棒，再次打开了整个巨大裂孔。(b) 在带后方周向放置一根棒，成功闭合了裂孔的未闭合部分。(3) 在巨大裂孔相对处巩膜增厚的情况下，要获得足够宽的扣带，最佳、最安全且最简单的解决方案之一是通过在斜向带的前缘和后缘相对处切开约一半巩膜厚度（甚至在斜向带下方进行板层巩膜切除术），在比裂孔子午线范围更宽的区域削弱裂孔后方的巩膜（莫尔塔达改良手术）。这有助于在较低的带紧度下实现扣带，从而避免压迫性葡萄膜病的任何并发症。
