Primary Retinal Detachment

Chapter 2
Prophylaxis in Fellow Eye of Primary Retinal
Detachment: What Not to Do and What to Do
Norman Byer
It is generally very helpful in understanding the present to make
a retrospective survey of the thinking of the past, which has led us
to our present concepts. The progression of ideas in the case of
prophylactic treatment of retinal detachment first developed from
a few correct elementary clinical observations, but then proceeded
on the basis of mostly theoretical reasoning because of the profound
dearth of empirical data.
Along with the early realization that some retinal detachments
could be successfully treated, other observations also began to be
made. Certain associated pre-existing retinal lesions began to be
observed in eyes in which causative retinal tears had led to retinal
detachment. It was thought that perhaps these associated lesions
were responsible for the onset of the retinal tears and, therefore,
were of prognostic importance. With the advance of more careful
retinal examination, more of these lesions began to be discovered
in the “fellow eyes” of patients who had had a retinal detachment
in their primary eyes and also in the eyes of patients who had not
suffered a retinal detachment.
The idea soon began to be entertained that perhaps retinal detachments
could be prevented, in the first instance, by “treating”
these associated lesions before the initiating retinal tears occurred.
Because natural history information regarding these various retinal
lesions was almost non-existent at that time, the concept of the
value of such “prophylactic” treatment rested on purely theoretical
reasoning. This gulf between theoretical expectations and actual
empirical data was easily, and unknowingly, bridged by several