Posterior unbuckled part of a giant tear behind the oblique encircling silastic 3 mm band operation. Surgical prevention and treatment.

(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.