Surgical Treatment of Retinal Detachment

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The first operation attempted for treatment of retinal detachment was by James Ware in 1805 who drained the subretinal fluid by puncturing the sclera with a knife [16]. In i863,von Graefe modified this method by also puncturing the retina and creating a second hole for the drainage of the subretinal fluid into the vitreous cavity [i7].G. Martin in 1881 and de Wecker in 1882 introduced the thermocautery (later popularized by Dor (1895-1907) as the method of puncture [18-20]).

Permanent drainage of subretinal fluid using trephining was advocated by de Wecker in 1872 and Argyll Robertson in 1876 [21, 22]. The introduction of Elliot's operation for glaucoma popularized trephining between 1915 and 1920 [9]. Groenholm in 1921 advocated the Holt pre-equatorial sclerectomy: the removal of a large disc of sclera so that the suprachoroidal space is in communication with subtenon's space [23]. In 1924, Wiener made two trephine holes 1 mm apart and threaded a strand of horse-hair into one hole and out of the other [24].

There were numerous other surgical methods attempted for retinal detachment. Subconjunctival injections were first suggested by Grossman in 1883 and then popularized by Mellinger in 1896 who used hypertonic saline to extract the subretinal fluid by osmotic forces [25, 26]. Division of vitreous fibers to treat retinal detachment was attempted by Deutschmann in 1895 [27]. Reduction of the globe capacity on the basis of von Graefe's theory that the cause of detachment was an increase in the volume of the eye in myopia was advocated by Leopold Mueller in 1903 [28]. Torok collected reports of 50 such procedures and found that none had permanent success [29]. Raising the intraocular pressure was advocated, postulating that the retina would be re-apposed by the high pressure in the eye. Lagrange in 1912 introduced colmatage, whereby triple rows of cautery were made underneath a conjunctival flap [30]. Carbone in 1925 recommended the injection of material

(vitreous, gelatin) into the anterior chamber to raise the intraocular pressure [31]. Others attempted to push the retina back towards the choroid by injecting various materials into the vitreous cavity. Deutschmann injected rabbit vitreous in 1895, Nakashima injected protein solutions in 1926, and Ohm (1911), Rohmer (1912), Jean-delize and Baudot in 1926, and Szymanski in 1933 injected air [27, 32-36]. Meyer in 1871 attempted suturing of the retina to an opening in the scleral wall and Galezowski in 1890 practiced suturing the retina to the choroid [37,38].

Many possible methods of retinopexy were attempted (cautery, electrolysis, and injection of irritant substances under the retina); however, they were all unsuccessful since there was no attention given to the closure of retinal breaks.

Although many procedures were proposed for the treatment of retinal detachment, the success rate was low. In 1912,Vail surveyed the ophthalmologists in the United States to report their success rate in treating retinal detachment. He concluded that the success rate was 1 in 1,000 and that the treatment modalities were ineffective [39].

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