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The fishmouth phenomenon. I. Clinical characteristics and surgical options.

A typical fishmouth retinal break is a large horseshoe-shaped tear, located near the equator, with an associated bullous retinal detachment. During scleral buckling and drainage of subretinal fluid, the break tends to open more widely, making its closure difficult. Clinical characteristics that permit preoperative anticipation of the fishmouth phenomenon and several surgical methods that were previously suggested for its management are reviewed. The surgical methods include: an equatorial implant with a meridional addition, a two-band procedure, broad scleral buckling, and episcleral silicone sponge. A radial, intrascleral, solid-silicone implant (wedge) with an encircling element is recommended, as are other technical maneuvers that may be helpful in troublesome cases.