Retinal Surgery

In the early part of the twentieth century, it was generally accepted that there was no known effective treatment for retinal detachment. It was realised that a period of bedrest resulted in flattening of the retina in many instances. This entailed a prolonged period of complete immobilisation, with the patient lying flat with both eyes padded. This treatment can restore the sight but only temporarily because the retina redetaches when the patient is mobilised. It was also dangerous for the patient in view of the risk of venous thrombosis and pulmonary embolism. In the 1920s, it began to be realised that effective treatment of retinal detachment depends on sealing the small holes in the retina (Figure 13.3). It was already known by then that the fluid under the retina could be drained off externally simply by puncturing the globe, but up till then no serious attempt had been made to associate this with some form of cautery to the site of the tear. Once it became apparent that cautery to the site of the tear combined with the release of subretinal fluid was effective, it also became evident that not all cases responded to this kind of treatment. It was almost as if the retina was too small for the eye in some cases, an idea that led to the design of volume-reducing operations, which effectively made the volume of the globe smaller. This, in turn, led to the concept of mounting the tear on an inward protrusion of the sclera to prevent subsequent redetachment.

Modern retinal reattachment surgery is carried out using either the cryobuckle or vitrectomy technique.

Figure 13.3. Retinal detachment a before and b after treatment. (After Gonin). Da
Figure 13.4. a Retinal detachment surgery: retinal tear surrounded by cryopexy and covered by indent. b Retinal detachment surgery: indent and encirclement band (with acknowledgement to Professor D. Archer). CD

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