Surgery of Vitreoretinal Disorders: Past, Present, and Future

Abstract

Pre-Gonin era: Retinal detachment has always been a dramatic and terrifying experience for the patient and for the surgeon a source of frustration for a long time. Practical knowledge in the nineteenth century was based on pathoanatomical observations, and the therapy consisted of drainage and bed rest. Invention and introduction of ophthalmoscopy by Helmholtz in 1851, enabling fundus visualization in vivo for the first time, marked the decisive step in understanding and treatment of retinal detachment. Nevertheless, it took 70 long years to totally comprehend the course and dynamics of the pathological process. The main components of this process—traction, fluid, current in the eye, as well as the hole in the retina—were observed separately but were not causally connected. The importance of particular components of the pathological process was either over- or underestimated, while the therapy itself relied on the surgeon’s assumptions. Cutting of the “vitreous strands” (Deutschmann and Graefe); intraocular injection of various substitutes with or without drainage of subretinal fluid; extensive diathermy (Lagrange); and shortening of the eyeball (Müller), combined with strict bed rest and positioning are some of many futile attempts whose rare positive results were at the most only temporary.