Treatment And Protocol For Retinal Detachment Cases
The outcome of retinal detachment treatment through the early 1900s was no better than approximately 5% utilizing any form of therapy, including subconjuctival injections of hypertonic saline solution, vitreous puncture, pilocarpine injections, or prolonged bed rest.
Gonin's treatment in 1920 was viewed with skepticism and controversy. At the 1929 meeting of the International Congress of Ophthalmology, Gonin reported a case series of his work indicating that 50% of the patients he treated by closing the retinal tears and draining subretinal fluid were cured. Over the next few years his work was verified by others and the treatment for retinal detachment began in earnest.
Gonin's original technique consisted of localizing the retinal tear, raising a conjunctival flap over the tear area, and cauterizing the area over the tear with either galvanocautery or the thermal cautery of Paquelin. The chorioretinal adhesion that was produced was not exuberant, but the vitreous-retina scleral adhesion that was formed was thought to be the contributing healing factor.
Soon after Gonin's discovery, advances in his technique occurred. Because this treatment could only be performed if a single hole was present, treatment for retinal detachment with multiple holes failed. Henricus Weve (1888-1961) introduced diathermy to produce a chorioretinal adhesion in 1932. Gonin and Carl Lindner (1883-1961) used this diathermy technique to create large areas of chorioretinal adhesion so that multiple retinal holes could be sealed. Ernst Custodis (1898-1990) developed a technique whereby an episcleral polyvinyl cylinder was placed on the sclera and using compression sutures, the choroid was pushed against the retina. The indentation technique was born! Lindner resected the sclera to produce a similar compression. Charles Schepens brought us the use of a practical binocular indirect ophthalmoscope that allowed better viewing of the retina preoperatively and intraoperatively. Schepens brought us the equatorial band, which, over the years, has found a significant role in the surgical repair of retinal detachment. His role as the mentor of two generations of retinal specialists cannot be understated. Today's success rate in repairing detachments is 90% or better.
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