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Primary Retinal Detachment

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Chapter 2<br />

Prophylaxis in Fellow Eye of <strong>Primary</strong> <strong>Retinal</strong><br />

<strong>Detachment</strong>: What Not to Do and What to Do<br />

Norman Byer<br />

It is generally very helpful in understanding the present to make<br />

a retrospective survey of the thinking of the past, which has led us<br />

to our present concepts. The progression of ideas in the case of<br />

prophylactic treatment of retinal detachment first developed from<br />

a few correct elementary clinical observations, but then proceeded<br />

on the basis of mostly theoretical reasoning because of the profound<br />

dearth of empirical data.<br />

Along with the early realization that some retinal detachments<br />

could be successfully treated, other observations also began to be<br />

made. Certain associated pre-existing retinal lesions began to be<br />

observed in eyes in which causative retinal tears had led to retinal<br />

detachment. It was thought that perhaps these associated lesions<br />

were responsible for the onset of the retinal tears and, therefore,<br />

were of prognostic importance. With the advance of more careful<br />

retinal examination, more of these lesions began to be discovered<br />

in the “fellow eyes” of patients who had had a retinal detachment<br />

in their primary eyes and also in the eyes of patients who had not<br />

suffered a retinal detachment.<br />

The idea soon began to be entertained that perhaps retinal detachments<br />

could be prevented, in the first instance, by “treating”<br />

these associated lesions before the initiating retinal tears occurred.<br />

Because natural history information regarding these various retinal<br />

lesions was almost non-existent at that time, the concept of the<br />

value of such “prophylactic” treatment rested on purely theoretical<br />

reasoning. This gulf between theoretical expectations and actual<br />

empirical data was easily, and unknowingly, bridged by several

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