Subscleral Scleral Burial in Surgery of Retinal Detachment.

IN recent years, various operative procedures have been described to bring the diathermy-treated choroid in apposition to the detached retina specially around retinal breaks. These operations may be divided into two groups: scleral shortening and sclero-choroidal introflexion. Scleral shortening was revived by Lindner (1933), whose operation is a modification of that of Muller (1903); this involved the removal of a large oval piece of sclera, about 8 x 20 mm., on the temporal side of the eyeball through a Kr6nlein exposure, paying no attention to retinal breaks. In Lindner's operation, retinal breaks are treated by diathermy and a long and narrow full-thickness strip of sclera is then excised usually along the temporal half of the equatorial region. Lindner's full-thickness scleral resection is technically difficult because of the risk of injuring the bulging choroid with attendant vitreous loss and choroidal haemorrhage. Shapland (1951) in England and Paufique (Barut, 1952) in France, described modifications for the full-thickness scleral resection. The modified operation is the lamellar sclerectomy in which a thin film of the deepest scleral lamellae is left in situ. Scleral shortening operations improved the results of retinal detachment surgery by bringing the choroid nearer to the retina, but the approximation is diffuse and not especially localized to the region of the retinal breaks. During the last decade two new methods have been introduced which aim at producing localized approximation between the choroid and the retina specially in the region of retinal breaks. In both methods a synthetic implant is stitched to the sclera to produce sclero-choroidal infolding. Custodis (1952, 1953, 1956) introduced a polyviol implant which is pressed by sutures against the diathermy-treated surface of the sclera in the region of the retinal breaks. Schepens, Okamura, and Brockhurst (1957, 1958), Okamura, Schepens, and Brockhurst (1959), and Brockhurst, Schepens, and