Tarsus as buckling material in retinal detachment surgery.

The hazards of synthetic implants and the difficulty of obtaining other autogenous or homogenous implant material may be avoided by using the tarsus from the upper lid of the operated eye as buckling material in retinal detachment surgery, especially in cases of localized detachment with one or more tears. After the adherent conjunctival material has been removed, the tarsus tissue can be placed in a scleral pocket overlying the tear. The size of the piece of tarsal tissue required depends on the size of the retinal tear and elevation of the detachment. The tarsus of the upper lid is about Io mm. in breadth, 29 mm. in length, and I mm. in thickness (Duke-Elder and Wybar, I96I). One tarsus is usually sufficient. If there is vitreous retraction, two tarsi placed one above the other may be used to produce a very high buckle. If the retinal tear is long, two tarsi may be placed end to end. If the tear is small, only a small piece of tissue is needed. The tarsus may be folded before use. If the retinal tears are in different quadrants the tarsal tissue is placed in separate scleral pockets overlying the tears. Fifteen cases of retinal detachment with tears have so far been operated upon using the fresh tarsus as buckling material. Cases with fixed retinal folds, contracting membranes on the retinal surface, massive vitreous retraction, or re-operations that needed encircling bands were not treated in this way. Only when the retina was not replaced by rest was the subretinal fluid evacuated by one diathermy needle puncture not penetrating the retina. The Table shows five typical examples of operated cases.