External buckling without drainage.

Scleral buckling without drainage of subretinal fluid is a technique suitable to a broad range of detachment problems including aphakia, vitreous traction, multiple tears, high myopia, and large breaks, as well as old or extensive detachment. Retinal detachments operated on by modification to the Custodis procedure reattach in a spontaneous and predictable manner determined by the patient's age, the duration of the detachment, and its extent. Ninety percent of cases are completely reattached four days following surgery. Clues to successful surgery when subretinal fluid persists are retinal tear closure, documented daily fluid loss, macular reattachment, and dependent shifting of subretinal fluid. When uncertainty still exists, the final objective evaluation is the observation that fluid fails to accumulate beneath the retina when the patient is unpatched and mobilized. The operation is extraocular and avoids the problems of drainage-choroidal hemorrhage, retinal incarceration, vitreous loss, and restoration of hypotony. The technique offers the modern surgeon a simple, direct, and rational approach applicable to 75 percent of retinal detachments, and it also assures a smooth, uncomplicated recovery.