Primary Retinal Detachment

Chapter 9
Repair of Primary Retinal Detachment:
The Present State of the Art and How It Came About
Ingrid Kreissig, Harvey Lincoff
A major advance in the concept of treating a primary rhegmatogenous
retinal detachment was the realization that the surgical problem
was solely closing the leaking retinal break and that the extent
of the detachment or tractional configurations remote from the
break are of no consequence. Let us share with you this change in
concept over time [1].
Recall, Gonin [2] postulated – for the first time – that a leaking
break is the cause of a retinal detachment, and his treatment was
limited to the area of this break.With his operation, the attachment
rate increased from 0% to 57%. However, this localized procedure
was soon modified to coagulations of the entire quadrant of the
leaking break. In 1931, Guist and Lindner [3, 4] circumvented further
the need for localizing the leaking break by doing multiple
cauterizations posterior to the estimated position of the break;
Safar [5] applied a semicircle of coagulations posterior to the break.
The intent was to create a “barrier” of retinal adhesions posterior
to the leaking break. As a result, the treatment was no longer limited
to the break, but was expanded over the quadrant in which the
break or presumed breaks were located.
In 1938, Rosengren [6] again limited – now for the second time
– the coagulations to the leaking break. In addition – and for the
first time – he added an intraocular tamponade of air, which was
positioned in the area of the break to provide an internal support
during the formation of retinal adhesion. Retinal attachment
increased to about 77% with Rosengren’s procedure.
However, the precise placement of coagulations around the
break was difficult, and the Rosengren technique was not widely