ABSTRACT
Jules Gonin developed the first successful operation for retinal detachment based on accurate pre- and intraoperative localization of retinal breaks, drainage of subretinal fluid, and thermocautery applied through a drainage sclerotomy. Buckling can be used successfully to treat the majority of rhegmatogenous retinal detachments without significant proliferative vitreoretinopathy. Absorbable sheets of gelatin are sometimes used as an exoplant or implant to treat retinal detachment. Ernst Custodis performed the first scleral buckling operation in 1949 with an episcleral polyviol exoplant using a nondrainage technique in nearly all cases. Scleral buckling can be performed under either local or general anesthesia, and the choice is often a function of surgeon preference and community standard of care. Patients undergoing a scleral buckling procedure were likely to require supplementation anesthetic or intravenous sedation in 48% of cases. Several alternative techniques of local anesthesia have been employed to avoid possible complications associated with retrobulbar or peribulbar injections with a needle.
