Controversy over the etiology and therapy of retinal detachment: the struggles of Jules Gonin.

Retinal tears were recognized as soon as ophthalmoscopy became available. They were initially considered to be secondary events, from choroidal exudation and pressure behind the detached retina. This led von Graefe and others to recommend cuts in the retina to drain subretinal fluid into the vitreous cavity. De Wecker (1875, 1879) and Leber (1882) first proposed that intrinsic tears within the retina are the cause of retinal detachment, but they faced extreme and long lasting opposition for this view. Surgical results at this time were uniformly disastrous, and therapeutic nihilism still prevailed when Dufour and Gonin became convinced around 1904-1906 that the retinal tear was indeed the origin of the detachment. It took ten years, however, before Gonin figured out how to close tears by exact placement of heat coagulation ("thermopuncture") and provide therapeutic evidence for his beliefs. When he first presented his results in 1921, colleagues jeered at him, especially Deutschmann and Sourdille who, like the other ophthalmic surgeons, denied the role of the tear (and still made "therapeutic" incisions through the detached retina). Recognition of Gonin's approach finally came at the International Congresses in Amsterdam 1928 and in Madrid in 1933. Sourdille modified his approach when his son Gabriel convinced him to change after 1930, but Deutschmann stuck to his horrific procedure until his death in 1935. Then a new generation of retinal surgeons took over, with subsequent discussion focused on finding the best methods to close the tears.