Experiences with the Linder-Guist operation.

IN dedicating this article to Professor Karl Lindner in honour of his 70th birthday, the author acknowledges a debt which he among many ophthalmic surgeons-and their patients-owes to this pioneer of the surgery of retinal detachment; a debt which, unlike other debts, must rejoice the creditor in the knowledge that it will ever grow and ever remain unpaid. Particular reference is made to Lindner's contribution to retinal surgery, because it is with methods of treatment of retinal detachment associated with the names of Lindner and Guist, that the author has concerned himself in recent years, and it was thought appropriate that his experiences with these methods should form the subject of this article. Though any interest it may have lies, to a great extent, in the modifications, which are described, of the original technique, there has been no change of principle. Furthermore, these same modifications, which the author once thought were original, have, in fact, been largely anticipated by Lindner himself. The great majority of retinal detachments are treated by the diathermy operation, the direct descendant of Gonin's ignipuncture. That this has its limitations, however, even in the most expert hands, is shown by the recent widespread renewal of interest in scleral resection, the revival and rationalization of which, in 1933, we owe to Lindner (1933a). Many articles on this operation have appeared in the literature of the past few years describing variations in technique and the results thereof (e.g. Pischel, 1945; Leopold, 1945; Vail, 1946; Lindner, 1949; Weve, 1951; Shapland, 1951; Philps, 1951; Lister, 1951). Another alternative or auxiliary to diathermy is the LindnerGuist operation (Guist, 1931, 1933; Lindner, 1931, 1932a, b, 1933b), and it is with this that this article is concerned. As is well known, the Lindner-Guist operation in its original form consists in surrounding the area of the retihal tear with a series of trephine holes in the sclera and applying caustic potash to the exposed choroid. In the early 1930s it was practised by a number of surgeons (Black, 1932; McKeown, 1933; King, 1933; Terrien, Veil, and Dollfus, 1933; Rieger, 1933; Shapland, 1934; Dunnington and Macnie, 1935-all quoted from Duke-Elder, 1940), but certain disadvantages have severely limited its popularity. First is the difficulty of trephining further back than about 16 mm. on the temporal side of the globe and 12-14 mm. in other segments. Second is the risk of in-