Evolution of Plastic Material in the Surgery of Retinal Detachment.

DURING the last decade retinal detachment surgery has undergone greater alteration in practice and technique than any other branch of ophthalmic surgery. So swiftly have the changes and modifications been introduced that proper evaluation of them has become clouded by their multiplicity. It has, therefore, become desirable to summarize the recent advances in historical sequence. Moreover, it should be remembered that these materials and operations were introduced to improve the prognosis of cases which were hitherto untreatable in the first instance, and only now are their indications in straightforward cases being critically assessed. The examination of current literature has been complicated by this issue, for results which appeared in many cases to be fair, were, in fact, good, when the material presented for trial was taken into account. An additional difficulty is the lack of an international standard by which to determine what constitutes a successful result. No one would dispute that the retina must be flat, but for how long must it remain so post-operatively? Some surgeons quote 3 months, whereas other feel that at least a year is necessary; the current figures are inconsistent and consequently without much value. The foundations of retinal surgery laid down by Gonin (1929) remain the guiding principles of to-day (Gonin, 1930a, b, 1933; Amsler, 1956). As Gonin himself stated, much of the surgeon's work in retinal detachment is already accomplished before the patient arrives in the operating theatre; localization of all the retinal tears, assessment of the extent of detachment, quantity of sub-retinal fluid, the state ofthe vitreous, its traction or collapse-all these factors are taken into consideration before planning a surgical procedure to suit the individual case. Retinal surgeons have seen three major new advances in the last 10 years: