Deutschmann's Operation

DEUTSCHMANN'S OPERATION (Deutschmann) was proposed by the author for retinal detachment under the influence of the theory of Nordenson and Leber, which attributed detachment to the shrinking of both the vitreous body itself and, in particular, the strands that developed within it. With the goal of acting specifically on these strands and freeing the retina from their traction, Deutschmann proposed his operation, which was initially performed as follows: at the site where the conjunctiva of the eye transitions to the lower fornix, externally-inferiorly and internally-inferiorly, Deutschmann made semilunar incisions in the conjunctiva and, having exposed the sclera, cauterized these areas with a thermocautery.

Figure 1. Then Deutschmann placed sutures on the conjunctival incisions and immediately (or shortly thereafter) with a narrow, double-edged, well-sharpened knife (of the Graefe type) made an entry at the site of the external-inferior cauterization and, having entered the eye cavity, advanced the knife, simultaneously cutting through the folds of the detached retina and the vitreous body, to the site of the internal-inferior scleral cauterization, where the knife was brought out through the retina, choroid, and sclera, while the conjunctiva was not punctured; as soon as the tip of the knife appeared beneath it (which is usually accompanied by the formation of a bleb of subretinal fluid), the latter (see Figure 1) was withdrawn, after which a bandage was applied to the eye and the patient was put to bed for eight days. Very soon, Deutschmann abandoned the preliminary cauterization; otherwise, the operation was performed with the further modification that the exit of the knife was made not quite symmetrically, but slightly higher, and also, when withdrawing the knife, an arcuate upward movement was made in the vitreous body (see Figure 2) for the purpose of greater dissection of the latter; furthermore, a slight rotation of the knife around its axis was made at the very last moment to facilitate the outflow of subretinal fluid. Subsequently, Deutschmann added to the puncture of the membranes further incisions of the detached retina in the region of the ora serrata, which are made in various places, depending on the localization of the detachment. Despite the rather significant trauma, the eye recovers quite quickly and tolerates the repeated application of punctures relatively easily. Deutschmann insists precisely on the repeated application of his operation (up to 20 times), and in his latest work, he indicates that after withdrawing the knife, he injects 1/2 to 3/5% dionin solution under the conjunctiva at the entry site. Deutschmann cites the following results of his operations: out of 593 eyes with detachment, of which 43 underwent injections of various substances into the vitreous body according to his own method, he considers 177 eyes cured, i.e., 21%; improvement was obtained in 191 cases (35.6%). If one excludes from this number the cases considered hopeless by the author but operated on for experimental purposes at the persistent requests of the patients, then 427 eyes remain, and the percentage of cure rises to 27.3, and improvement to 44.7. However, it must be noted that in the hands of other ophthalmologists, this operation did not yield such brilliant results, and this method is not generally accepted.

Figure 2. scl—sclera; ch—choroid; ret—retina; — path of the knife during entry; ----- arc described by the tip of the knife during exit.