As the years pass, medical science is moving gradually away from the principle of curing disease towards the greater achievement of its prevention. To further this end, community health services are being developed, and pilot studies have already been undertaken in the screening of the population to assist in the early diagnosis of a number of conditions, among them glaucoma. The increased specialization of post-graduate training is providing greater expertise in retinal diagnosis and treatment, and there have been, particularly during the last two decades, substantial advances in the recognition of vitreous and retinal changes which predispose to the development of retinal detachments. More than a century ago, Coccius (I853) described retinal breaks, but it was not until 67 years later that Gonin (1920) correctly interpreted their significance. The observation that retinal breaks were the pathological lesions that led to retinal detachments inspired many workers to investigate the methods by which the breaks could be sealed and choroidoretinal apposition restored. Weve (I930) introduced diathermy as an alternative to electrocautery or chemical cauterization. At the Fourteenth International Ophthalmological Congress in Madrid, Lindner (I933a) discussed the possibility of preventing retinal detachment. He prophesied that one day an operative method would be developed to achieve this. In the same year Bietti (I933) described the use of cryotherapy in the treatment of retinal detachment, a discovery that was to be overlooked until Cooper (i 962) described the principles and rationale of cryogenic surgery, and outlined the use of a cryotherapy instrument using liquid nitrogen as a coolant. Lincoff and McLean (I965) saw a future for this method of producing choroido-retinal reaction in retinal surgery, and published their observations after animal experiments and clinical trials. Major advances have since been made in instrumentation, and both simple and sophisticated instruments are now available. Examples of these are the Amoils cryosurgical unit (Amoils, I966) and the Amoilette which uses either nitrous oxide or carbon dioxide (Fison and Wright, 1968). Between the original description of cryotherapy and its widespread application there were numerous developments in surgical technique, beginning with scleral surgery. Fullthickness scleral resection (Miiller, I903; Lindner, I933b) was succeeded by the lamellar procedure (Shapland, 1951, 1952), and the latter has remained in use until recently. Indeed, there are still indications for this method. Episcleral implants or implants introduced into scleral pockets began with the use of polyviol materials by Custodis (I95I) and of preserved sclera by Paufique (I963). A number of natural and synthetic materials have subsequently been described, those most commonly used at the present time being silicone rubber and silicone rubber sponge. Encircling techniques began with the Arruga
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Jun 25, 2009
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