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The choice of whether to perform scleral buckling is an individualized decision, but surgeons are less likely to perform primary scleral buckling without PPV if there are extensive PVR membranes, posterior breaks, RD associated with vitreous haemorrhage or macular hole, poor visualization of the retina due to cataract or corneal pathology, which precludes accurate identification of breaks during surgery, and conditions associated with thin sclera, scleral infection, or conjunctival fibrosis 88

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