RETINA PIONEER

Jules Gonin

1870-1935

Contributed by: Arhum Mahmood, MD (cand)

Jules Gonin was born in Lausanne, Switzerland on August 10, 1870. He was raised in a family who placed grave importance on culture and religious faith. In secondary school he began to reveal his remarkable ability to learn languages. He spoke French, Swiss, German, and then later added Latin, Greek, English, Spanish, and Italian.[2]

Jules Gonin departing the Eye Hospital after seeing patients. Photo source: Indian Journal of Ophthalmology.

In 1888, Gonin joined the College of Science and studied medicine at the University of Lausanne. He completed many research studies on butterflies, earned a distinction from the University, and then entered the institute of Pathology in Lausanne. After travelling to hospitals all around Europe between 1894-1895, he developed an interest in ophthalmology. In 1896, he began training under Dr. Marc Dufour, the first professor of ophthalmology in Lausanne and director of the Eye Hospital. While working at the Eye Hospital, Gonin became more prominent and was given the title of Privat-Docent which implied great teaching commitments. Subsequently, in 1908, he became the first president of the Swiss Ophthalmological Society which he cofounded. Finally, in 1918, he became director of the Lausanne Eye Hospital and two years later was appointed Professor of Ophthalmology at the University of Lausanne. [2,4]

While working in the outpatient clinic, Gonin worked on research projects on diverse topics such as bacterial conjunctivitis, ocular tumors, and hereditary retinopathies. From 1902 to 1921, he immersed himself in research about retinal detachment. Gonin and Dufour focused on not only seeing the retina was torn, but also finding the cause and treatment of retinal detachment. In 1902, Dr. Dufour assigned Gonin with the task of writing a chapter on retinal detachments for the French Encyclopedia of Ophthalmology. Gonin’s first publication discussed the topic of the pathogenesis of spontaneous retinal detachment which he studied in 3 enucleated eyes. In 1904, he presented a paper to the International Congress in Lucerne about the role that the vitreous may have in traumatic retinal detachment. The fourth volume of the French Encyclopedia of Ophthalmology was released in 1906, and Gonin’s work was well received due to his detailed illustrations. Gonin explained the necessity of understanding the pathogenesis of spontaneous detachment in order to find a treatment for the condition. [4]

Between 1919 and 1934, Gonin published 40 papers on the pathogenesis and surgical treatment of retinal detachment and its outcomes. He emphasized that the hole was not a result of the retinal detachment, rather, the hole was the cause of the retinal detachment. Thus, concluding that retinal detachment could be treated by closure of the hole formed by the retinal break, leading him to develop his trademark breakthrough known today as the ignipuncture, a technique of treating retinal breaks using cauterization to induce a chorioretinal scar resulting in closure of the break. [5]

In this procedure, first, Gonin would carefully localize the breaks in the retina with direct ophthalmoscopy. He then ordered strict bedrest  with the eyes patched and in a position to allow resorption of subretinal fluid. Once the subretinal fluid has resolved, Gonin would incise the conjunctive, and mark the site of the break on the sclera. Then, he would inject novacaine into the subconjunctival space, pierced the sclera with the Graefe knife and then apply the curve thermocautery to theretinal break through the sclerotomy. The thermocauterization induced a chorioretinal scar where it was applied to help close the retinal tear. Finally, the conjunctiva was closed with sutures. [5]

Using the ignipuncture technique, Gonin first treated a traumatic retinal detachment in 1913 and in 1916, he treated an idiopathic retinal detachment. With this new method of managing retinal detachment, the cure rate of retinal detachment from rose 1% to 30-40%. [6]

However, it was not until 1929 that Gonin received worldwide recognition at the International Ophthalmological Congress in Amsterdam for his surgical procedure, along with being awarded the Benoitprice, the highest scientific honor in Switzerland

In his final years, Gonin was particularly busy with his daily position as chairman of the Hospital as well as management of difficult cases from around Europe that came to him to benefit from his expertise. Despite his increasing demands from work, Jules Gonin published his book on retinal detachment surgery called “Ledιcollement de la rιtine” Today, his legacy lives on by the University Eye Hospital in Lausanne which was named after him and by the Gonin Medal, an award established by the University of Lausanne and the Swiss Ophthalmological Society that is awarded by the International Council of Ophthalmology every four years for the highest achievements in ophthalmology. [6]

As surgeons of today use state of the art vitreoretinal technology for the treatment of their diseases, they must remember the advancements that were made possible through scientists such as Jules Gonin.

highlights

1904

Presented to the International Congress in Lucerne on role of the vitreous in traumatic retinal detachment

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1906

4th volume of French Encyclopedia of Ophthalmology released, giving Gonin worldwide recognition

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1908

Co-founder and first president of the Swiss Ophthalmological Society

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1913

First treatment of traumatic retinal detachment using ignipuncture procedure

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1916

First treatment of idiopathic retinal detachment using ignipuncture procedure

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1928

Awarded the Benoit Prize, highest scientific honor in Switzerland

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1929

Received worldwide recognition at the International Ophthalmological Congress in Amsterdam

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1930, 1934, 1935

Nominated for the Nobel Prize in Medicine

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1934

Published his book on retinal detachment, called “Le decollement de la retine”

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1938

Establishment of the Gonin medal by the University of Lausanne and Swiss Ophthalmological Society

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1896-1935

  • Ophthalmologist at Eye Hospital, Lausanne

1903

  • Privat-Docent Promotion

1918-1935

  • Director of the Eye Hospital, Lausanne

1920-1935

  • Professor of Ophthalmology, University of Lausanne

1902-1935

  • Ophthalmological Researcher

Education & Training

1888: Medical Education at University of Lausanne Collegeof Science

1894-1895: Hospitals in Paris, London, Berlin, Heidelberg, Vienna, Prague

1896: Ophthalmology Training at the Eye Hospital, Lausanne

Illustration of the ignipuncture procedure. After localizing the retinal tear, the conjunctiva is incised in that area, the surgeon pierces the sclera with the Graefe knife and applies the curved thermocauter, which had been heated white, to the retinal tear through the small sclerotomy in order to induce a retinal scar.

Photo source: Indian Journal of Ophthalmology

Left: Illustration of retinal detachment in a left eye with a single break in the superonasal quadrant Right: Same eye after ignipuncture procedure, with the retina attached and chorioretinal scar present around the retinal break

Photo source: Indian Journal of Ophthalmology.

References:  

  1. Gonin J. Le décollementde rétine. 1934, Lausanne: Payot.
  2. Morais FB. Jules Gonin and the Nobel Prize: pioneer of retinal detachment surgery who almost received a Nobel Prize in medicine. Int J Retina Vitreous. 2018 Jan 15;4:2. doi:10.1186/s40942-017-0106-7. PMID: 29372074; PMCID: PMC5767977.
  3. Schnetzler, J. (1985).Histoire de la Fondation de l, Asile des aveugles. Asile des Aveugles, Lausanne, 1843e1985. Renens: Les presses de Grafiheld.
  4. Sen M, Honavar SG. Dr Jules Gonin: Burning the Hole. Indian J Ophthalmol. 2021 Mar;69(3):485-486.doi: 10.4103/ijo.IJO_238_21. PMID: 33595461; PMCID: PMC7942059.
  5. Wilkinson CP, Rice TA(1997) Michels retinal detachment, 2nd edn. Mosby St. Louis MO. pp 241-333.
  6. Wolfensberger, Thomas JMD, PD, MER Jules Gonin. Pioneer of Retinal Detachment Surgery, Indian Journalof Ophthalmology: Volume 51 - Issue 4 - p 303-308.