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Primary Retinal Detachment

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Post-Gonin Era 5<br />

into the subretinal space to detach the retina. The major contribution<br />

of Jules Gonin was to show that retinal breaks are the main<br />

cause of retinal detachments and that successful reattachment of<br />

retinas was dependent on the sealing of such breaks [7, 8, 41]. His<br />

procedure required a meticulous retinal examination and search for<br />

breaks. In 1918, he told the Swiss Ophthalmologic Society that the<br />

cause of idiopathic retinal detachment was the development of retinal<br />

tears due to tractional forces caused by the vitreous [42, 43]. In<br />

1920, he reported to the French Ophthalmologic Society that he had<br />

cured retinal detachments by application of cautery to the sclera<br />

over retinal breaks (first operations in 1919) [8]. Many did not believe<br />

him. In 1929, at the International Congress of Ophthalmology<br />

in Amsterdam, Gonin (along with his disciples Arruga, Weve, and<br />

Amsler) conclusively proved to his audience that retinal breaks were<br />

the cause of retinal detachment and that closure of retinal breaks<br />

caused the retina to reattach [42, 43]. During Gonin’s era, the success<br />

rate exceeded 50%. At this time, many procedures were proposed<br />

which we will summarize here from the historical standpoint.<br />

Gonin’s original procedure was to accurately localize the retinal<br />

break on the sclera [44]. Localization required estimating the distance<br />

of the break from the ora serrata in disc diameters, multiplying<br />

that figure by 1.5, then adding 8 mm to determine the distance<br />

of the break from the limbus. After measurement in the<br />

meridian of the break, a Paquelin thermocautery, heated till becoming<br />

white, was inserted into the vitreous. When the needle was<br />

withdrawn, there was drainage of subretinal fluid and incarceration<br />

of the edges of the break in the drainage site. In successful<br />

cases, there was subsequent closure of the edges of the break in the<br />

drainage site. During this procedure, subretinal fluid was sometimes<br />

only partially drained and he observed that, if breaks were<br />

sealed, the residual fluid would usually absorb. The majority of<br />

procedures for the next 20 years were variants of Gonin’s operation<br />

with modifications in the method of treatment of breaks and the<br />

method of drainage. Significant advances were the use of intraocular<br />

air to close retinal breaks and the early experimentation

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