Changing patterns in the surgery for retinal detachment: 1929 to 2000

To examine the development of surgery for retinal detachment in this century and to determine whether the countless innovations and modifications fall into a recognizable pattern.

The authors, whose entire professional life has been devoted to the treatment of retinal detachment, have made a retrospective analysis of their experience in the field of retinal surgery. They have reviewed their notes of the annual meetings of the Retina Society, the Retinological Society, and the biennial meetings of the Gonin Club, all of which they attended, and augmented this with an in-depth review of the literature.

Four conceptual advances by Jules Gonin, Bengt Rosengren, Ernst Custodis and Robert Machemer and countless modifications by a new category of specialists, the retinal surgeons, merge into two general patterns for the surgical repair of retinal detachment. The one is a local operation confined to closing the retinal breaks, the other is a circumferential operation intended to barricade the breaks and the peripheral retina. Both were extraocular operations. The more recent intraocular procedures, pneumatic retinopexy and vitrectomy, although apparently unique, nevertheless, fall into one or the other pattern.

Surgery for retinal detachment has improved the prognosis from 0% before 1929 to near 100%. Reducing morbidity and the incidence of reoperation remain a worthy objective for the coming century.