Surgical techniques for repair of primary retinal detachment: part I. Review of their development during the last 80 years

Abstract

Objective: To analyse the evolution of surgical approaches to repairing primary rhegmatogenous retinal detachment and the issues which had determined the changes starting from 1929 to the present.

Material and methods: Literature of retinal detachment surgery during the past 80 years is reviewed. There was a change from surgery of the entire retinal detachment to surgery limited to the retinal break and a change from extraocular (e.o.) to intraocular (i.o.) surgery to achieve retinal reattachment.

Results: All four surgical approaches to the repair of a primary retinal detachment have still one common premise for sustained success: finding and closing the retinal break which caused the retinal detachment and which would cause a redetachment, if not sealed off sufficiently. This is regardless of whether the surgery is limited to the area of the break or extends over the entire detachment, as well as whether it is performed as an e.o. or i.o. procedure.

Conclusion: Finding and closing the leaking retinal break in a primary detachment once and for all have accompanied the efforts of retinal detachment surgeons like a red thread over the past 80 years and are still the premises for sustained reattachment. However, four postulates will have to be fulfilled: (1) Retinal reattachment should be achieved with only a single operation, (2) the surgery should have a minimum of morbidity, (3) it should not cause secondary complications jeopardizing regained visual acuity during subsequent years, and (4) the surgery should be performed on a small budget and under local anesthesia.