Primary Retinal Detachment
Primary Retinal Detachment
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