The History of Retinal Detachment Surgery
Retinal detachment was once one of the most feared eye conditions because successful treatment was exceptionally uncommon. Before Jules Gonin transformed understanding of rhegmatogenous retinal detachment in the early twentieth century, reported surgical success rates were below 5%.
Today, your retinal surgeon may use pars plana vitrectomy, scleral buckling or, in carefully selected cases, pneumatic retinopexy. These procedures developed from a central insight that still guides treatment: retinal breaks need to be identified and sealed while your retina is brought back into contact with the tissues beneath it.
What Is a Retinal Detachment?
A retinal detachment occurs when your light-sensitive neurosensory retina separates from the underlying retinal pigment epithelium. In a rhegmatogenous retinal detachment, a tear or hole allows fluid to pass underneath your retina and separate it from the tissues that normally support it.
Other forms of retinal detachment can develop because scar tissue pulls on your retina or because fluid accumulates beneath it without a retinal break. Most of the surgical history described in this article concerns rhegmatogenous retinal detachment, which is the form treated by identifying and sealing retinal breaks.
Why Was Retinal Detachment Once Considered Untreatable?
Before the twentieth century, surgeons did not properly understand the relationship between retinal breaks and retinal detachment. Some early theories even regarded retinal tears as a consequence of the detachment rather than its cause.
Without identifying and closing the retinal break, treatment was rarely successful. Historical accounts report surgical success rates below 5% before Gonin’s work changed this understanding.
Jules Gonin Changes Retinal Surgery
Swiss ophthalmologist Jules Gonin transformed retinal detachment surgery by recognising that retinal breaks were a fundamental cause of rhegmatogenous retinal detachment. He presented his findings to the Swiss Ophthalmological Society in 1919 and subsequently developed ignipuncture, which used trans-scleral thermal cautery to treat the break.
For you as a modern patient, the importance of Gonin’s discovery is that treatment became directed towards the actual retinal break. His work changed retinal detachment from an almost invariably blinding disorder into a condition that could increasingly be repaired surgically.
Gonin’s Three Surgical Principles
Gonin established principles that still influence retinal detachment surgery today: identify every retinal break, create adhesion around it and bring the break back into contact with the underlying retinal pigment epithelium.
These principles helped surgeons understand how to repair your retinal detachment more effectively. The aim is to identify and seal the break while restoring contact between your retina and the underlying retinal pigment epithelium.
Why Was Gonin’s Discovery Revolutionary?
Gonin demonstrated that successful treatment depended on locating and closing the retinal break rather than simply attempting to drain the detached retina. Historical reports describe dramatic improvements in reattachment after this approach was introduced.
Your modern operation uses much more sophisticated instruments, imaging and internal or external support, but treating the retinal break remains central to rhegmatogenous retinal detachment repair.
The Development of Scleral Buckling
Ernst Custodis performed an early episcleral buckling operation in 1949, using an external implant to indent the wall of the eye without routinely draining subretinal fluid. His work provided an important foundation for modern scleral-buckling surgery.
Charles Schepens and colleagues subsequently developed and popularised more extensive buckling techniques during the early 1950s, helping scleral buckling become the principal retinal detachment operation for many years.
Key Points About Scleral Buckling
| Aspect | What It Means | Why It Matters to You |
| Early milestone | Custodis performed an early episcleral buckle in 1949 | It helped establish external retinal support |
| External implant | A silicone buckle is secured to your sclera | Your retina is supported from outside the eye |
| Scleral indentation | The buckle indents the eye wall towards the retinal break | This helps reduce traction and support closure of the break |
| Retinopexy | Cryotherapy or laser creates adhesion around the retinal break | This produces a longer-term biological seal |
| Ongoing support | A permanent buckle commonly remains in place | It can continue to support the treated area |
| Patient selection | Buckling remains useful for selected detachments | Age, lens status and the characteristics of the retinal breaks influence the choice |
How Does a Scleral Buckle Work?
Your scleral buckle indents the outer wall of your eye towards the retinal tear. This reduces the forces keeping the break open and helps bring your retina and retinal pigment epithelium back into contact.
Your surgeon will normally combine this mechanical support with retinopexy around your retinal break. The buckle can remain around your eye after healing and usually does not need routine removal. Current NHS retinal services continue to use scleral buckling for selected retinal detachments.
Charles Schepens and Modern Buckling
Charles Schepens helped develop and popularise scleral buckling in the early 1950s. His work included broader buckling approaches and advances in examining the peripheral retina that made localisation of retinal breaks more reliable.
Your surgeon may still consider an encircling or segmental buckle when the characteristics of your retinal detachment make external support advantageous.
Harvey Lincoff Refines the Technique
Harvey Lincoff introduced important modifications to the Custodis scleral-buckling technique during the mid-1960s, including silicone sponge implants, cryotherapy in place of diathermy and refinements in scleral suturing.
- Silicone sponges: These implants helped your surgeon create controlled support around the outside of your eye
- Cryotherapy: Freezing treatment can create a scar-like adhesion around your retinal break to help seal the area
- Improved sutures: Refined suturing techniques allowed your surgeon to position and secure the buckle more precisely
- Retinal support: The buckle helps indent the wall of your eye towards the retinal break, supporting the area as your retina heals
- Surgical precision: These developments helped make scleral buckling more consistent and effective for treating retinal detachment
If you need scleral buckling, these advances can help your surgeon support your eye and address your retinal break more precisely. The aim is to close or support the retinal break so that your retina can heal and remain attached.
The Introduction of Cryotherapy
Cryotherapy applies controlled freezing around your retinal break to create a chorioretinal adhesion. As this area heals, scar formation helps produce a durable seal between your retina and the underlying tissues.
Lincoff helped establish cryotherapy within modern scleral-buckling surgery as an alternative to older diathermy techniques. Cryotherapy remains used in selected retinal detachment procedures today.
Laser Photocoagulation
Retinal photocoagulation began before modern lasers were available. Gerhard Meyer-Schwickerath pioneered therapeutic retinal light coagulation during the late 1940s, initially using focused sunlight and later high-intensity artificial light sources such as the xenon arc. These techniques showed that controlled retinal burns could create chorioretinal adhesion.
Laser technology became available during the 1960s and subsequently provided a more controlled method of retinal photocoagulation. Today, retinal laser can be used to create adhesion around suitable retinal tears and during retinal detachment repair, helping prevent fluid from continuing to pass through a treated break.
The Birth of Pars Plana Vitrectomy
Robert Machemer performed his first closed pars plana vitrectomy on 20 April 1970, using an early vitreous infusion-suction-cutting instrument. The landmark description of the pars plana approach was subsequently published in 1971.
Vitrectomy transformed retinal surgery because your surgeon could remove vitreous traction from inside your eye and directly access retinal breaks, scar tissue and other abnormalities that were difficult to manage with external surgery alone.
Why Did Vitrectomy Transform Treatment?
During vitrectomy, your surgeon removes vitreous gel that is pulling on your retina and treats the responsible retinal breaks. Your retina can then be flattened and the break sealed with laser or cryotherapy.
A gas bubble or silicone oil may subsequently be placed inside your eye as an internal tamponade. These materials support the treated break while the chorioretinal adhesion develops.
The Development of Gas Tamponade
The use of intraocular gas in retinal detachment surgery began in the early twentieth century. Ohm reported intravitreal air for retinal detachment in 1911, and Rosengren reported further use of air tamponade in 1938. Modern expansile gases developed later, with sulphur hexafluoride, or SF6, becoming an important vitreoretinal tamponade during the early 1970s.
If your surgeon uses gas today, the bubble provides temporary internal support across your retinal break while laser or cryotherapy forms a permanent seal. You may need specific postoperative positioning depending on where your break is located.
Silicone Oil in Complex Detachments
Paul Cibis and colleagues reported the use of liquid silicone in retinal detachment surgery in 1962. This predated widespread modern pars plana vitrectomy, and silicone oil became more broadly established in vitreoretinal surgery during later decades.
Your surgeon may use silicone oil when longer-lasting internal support is desirable, particularly in selected complex retinal detachments. Unlike gas, silicone oil does not disappear naturally and often requires another operation for removal. It can also be associated with complications including cataract, raised eye pressure and emulsification.
The Development of Pneumatic Retinopexy
George Hilton and W. Sanderson Grizzard published their description of modern pneumatic retinopexy in 1986 as a two-step outpatient operation without a conjunctival incision. Their procedure combined intraocular gas with retinopexy and postoperative positioning.
Air and intraocular gas had already been investigated for retinal detachment many decades earlier. Hilton and Grizzard’s contribution was the development and description of the modern pneumatic retinopexy approach, combining intraocular gas, retinopexy and postoperative positioning for selected retinal detachments.
Why Is Pneumatic Retinopexy Different?
Pneumatic retinopexy can avoid the larger surgical intervention involved in vitrectomy or scleral buckling. Your surgeon places a gas bubble inside your eye and uses cryotherapy or laser to produce a lasting seal around the responsible retinal break.
The procedure is suitable only for selected rhegmatogenous retinal detachments. Break location, number and extent, your ability to maintain postoperative positioning and other retinal findings all influence whether it is appropriate.
How Is Retinal Detachment Surgery Performed Today?
Today, the main operations for rhegmatogenous retinal detachment include pars plana vitrectomy, scleral buckling and pneumatic retinopexy in carefully selected cases. Laser photocoagulation or cryotherapy is used to create adhesion around retinal breaks as part of treatment when appropriate.
The operation your surgeon recommends depends on factors such as the position and number of retinal breaks, the extent of the detachment, whether your macula is involved, your lens status, vitreous traction and other characteristics of your eye.
Modern retinal detachment surgery is often successful in reattaching the retina, although some people require more than one operation. Successful anatomical reattachment does not guarantee that your vision will return to its previous level, particularly when the macula has been detached.
UK Guidance Note
Retinal detachment requires urgent assessment because delaying treatment can increase the risk of permanent sight loss. Seek urgent eye-care assessment if you develop sudden new or increasing floaters, flashing lights, a dark curtain or shadow across your vision, or sudden deterioration in your sight.
If a gas bubble is placed inside your eye during surgery, you must not fly until your ophthalmology team confirms that the gas has completely disappeared. You should also tell any healthcare professional treating you that you have an intraocular gas bubble, particularly if you require an anaesthetic, because nitrous oxide can cause the bubble to expand dangerously.
Myth vs Fact
| Myth | What You Should Know |
| Your retinal detachment was always considered treatable. | Before Gonin’s work, successful surgery was exceptionally uncommon. |
| Gonin invented every principle used in modern retinal surgery. | His discovery that retinal breaks cause rhegmatogenous detachment provided the foundation from which modern surgical principles developed. |
| Your first scleral buckle was developed by Schepens. | Custodis performed an early episcleral buckle in 1949, while Schepens subsequently developed and popularised modern buckling approaches. |
| Retinal laser treatment began in the early 1950s. | Early retinal photocoagulation used intense light; modern laser photocoagulation developed later. |
| Vitrectomy was invented in 1971. | Machemer performed his first closed pars plana vitrectomy in 1970 and published the landmark technique in 1971. |
| Gas was first placed in an eye during the 1970s. | Air had been used much earlier; modern expansile gases such as SF6 became important in the 1970s. |
| Silicone oil disappears naturally like gas. | Your silicone oil usually remains until your surgeon decides whether it should be surgically removed. |
| Pneumatic retinopexy is suitable for every retinal detachment. | Your retinal breaks and other features must meet appropriate selection criteria. |
| Successful reattachment guarantees your vision will return to normal. | Your visual outcome also depends on factors such as whether your macula detached and how long the detachment was present. |
Key Takeaways
- Your modern retinal detachment surgery developed largely from advances in treating rhegmatogenous retinal detachment.
- Your retinal break became the central target of treatment because of Jules Gonin’s work.
- The likelihood of successful retinal reattachment improved dramatically as these surgical principles and techniques developed.
- Early scleral-buckling techniques developed during the late 1940s and early 1950s.
- Your modern buckle may support the retina externally while the retinal break heals.
- Your retinal photocoagulation developed from early light-based treatment before modern lasers became available.
- Modern pars plana vitrectomy developed from Robert Machemer’s work beginning in 1970.
- Your gas or silicone oil tamponade provides temporary or longer-lasting internal retinal support.
- Your pneumatic retinopexy is suitable only for carefully selected rhegmatogenous detachments.
- Your retinal detachment remains an urgent eye condition despite major improvements in surgical success.
Frequently Asked Questions
- When did retinal detachment surgery first become successful?
Your modern treatment has its foundations in Jules Gonin’s early twentieth-century work showing that retinal breaks cause rhegmatogenous retinal detachment and need to be closed. - Why was Jules Gonin important to retinal surgery?
Gonin recognised that your retinal break was a cause of rhegmatogenous retinal detachment rather than simply a consequence. This changed treatment towards finding and sealing the responsible break. - When was scleral buckling developed?
Ernst Custodis performed an early episcleral buckling procedure in 1949. Charles Schepens and Harvey Lincoff subsequently made major contributions to the development and refinement of modern buckling surgery. - What is scleral buckling?
Your surgeon places a supportive implant on the outside of your eye to indent the sclera towards your retinal break. This helps relieve traction and allows the break and surrounding retina to heal. - When was pars plana vitrectomy developed?
Robert Machemer performed his first closed pars plana vitrectomy in 1970, with the landmark pars plana technique published in 1971. - Why is gas used during retinal detachment surgery?
Your gas bubble provides temporary internal support across the treated retinal break while laser or cryotherapy forms a lasting adhesion. - When was silicone oil introduced?
Cibis and colleagues reported silicone oil for retinal detachment surgery in 1962. It later became particularly valuable for selected complex detachments. - When was pneumatic retinopexy introduced?
Hilton and Grizzard described the modern pneumatic retinopexy technique in 1986, combining intraocular gas, retinopexy and postoperative positioning. - What are the main retinal detachment operations today?
Your main surgical options for rhegmatogenous retinal detachment are pars plana vitrectomy, scleral buckling and pneumatic retinopexy, with combinations used when appropriate. - How does your surgeon choose the operation?
Your surgeon considers the position and number of retinal breaks, extent of detachment, macular involvement, lens status, vitreous traction and other characteristics of your eye before recommending treatment.
Final Thoughts: The History of Retinal Detachment Surgery
The history of retinal detachment surgery shows how advances in understanding retinal tears, surgical techniques and internal eye support transformed a once almost untreatable condition into one that can often be repaired successfully. From Gonin’s pioneering work to scleral buckling, vitrectomy and pneumatic retinopexy, each development has improved the ability to reattach and protect your retina.
Today, the most appropriate treatment depends on the type and location of your retinal detachment and the individual characteristics of your eye. If you are concerned about a retinal detachment or would like to discuss your treatment options, contact us at Eye Clinic London.
References
- Kreissig, I. (2016) ‘Primary retinal detachment: A review of the development of techniques for repair in the past 80 years’, Taiwan Journal of Ophthalmology, 6(4), pp. 161–169. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5525625/
- Xiong, J., Tran, T., Waldstein, S.M. and Fung, A.T. (2025) ‘A review of rhegmatogenous retinal detachment: past, present and future’, Wiener Medizinische Wochenschrift, 175(7–8), pp. 186–202. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12031774/
- Fallico, M., Alosi, P., Reibaldi, M., Longo, A., Bonfiglio, V., Avitabile, T. and Russo, A. (2022) ‘Scleral Buckling: A Review of Clinical Aspects and Current Concepts’, Journal of Clinical Medicine, 11(2), Article 314. Available at: https://www.mdpi.com/2077-0383/11/2/314
- Lincoff, H.A., Baras, I. and McLean, J.M. (1965) ‘Modifications to the Custodis procedure for retinal detachment’, Archives of Ophthalmology, 73, pp. 160–163. Available at: https://pubmed.ncbi.nlm.nih.gov/14237781/
- Lincoff, H.A. and McLean, J.M. (1965) ‘Cryosurgery in treating retinal detachment and other eye disorders’, British Journal of Ophthalmology, 49(7), pp. 337–346. Available at: https://pubmed.ncbi.nlm.nih.gov/5828911/