Intraocular Tamponade

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Another technique to help appose retina and choroid that could be used in conjunction with other procedures was injection of air into the vitreous cavity. Originally described by Ohm in 1911 and then by Rohmer in 1912, injection of air at the end of the operation was adopted by Arruga in 1935, and to close retinal breaks by Rosengren in 1938 [32, 34,139]. Rosengren carefully localized retinal breaks, then placed penetrating diathermy in a pattern covering an area 6-7 mm in diameter with drainage of subretinal fluid. He injected air into the vitreous cavity, then positioned the patient postopera-tively such that the air bubble closed the retinal breaks and ap-posed the retina to the RPE. Rosengren reported successful retinal reattachment in 75% of 300 cases with the technique [45].

Later Norton concluded that large breaks may respond better to tamponade by air than by a scleral buckle alone; however, air did not persist long enough in the eye [140]. He introduced sulfur hexafluoride (SF6) gas for internal tamponade of retinal breaks. Pure SF6 expands approximately twice its injected volume in the eye and persists twice as long as a comparable air bubble. Inert per-fluorocarbon gases, introduced by Vygantas (C4F8) and Lincoff (C2F6, C3F8, C4F10), expanded more and lasted even longer than SF6 in the eye [141,142].

Cibis in 1962 was the first to report the use of silicone oil for treatment of retinal detachment [143]. The complications of sili-cone oil made its usage unfavorable at that time. Haut in 1978 introduced the use of silicone oil with vitrectomy [144]. Zivojnovic became the major advocate of silicone oil in combination with "retinal surgery" (relaxing retinectomy) to treat severe proliferative vitreoretinopathy and traumatic retinal detachments [145]. Parke and Aaberg first reported the technique of argon laser endo-photocoagulation in conjunction with vitrectomy, retinectomy, and intraocular gas for the management of PVR [146]. Development of air pumps was also an important landmark, so retinas could be reattached with a fluid-air exchange in a controlled fash ion [147]. Perfluorocarbon liquids which were originally evaluated as blood substitutes were first used as a vitreous substitute by Haidt in 1982 [148]. Chang later popularized the use of perfluorocarbon liquids for the clinical management of certain types of retinal detachments and giant tears [149,150].

Retinal detachment surgery has come a long way since it was first successfully performed by Gonin. The past 50 years mark the evolution of this surgery, reaching success rates of 90% or higher. The future of retinal surgery most likely will be reduction in the morbidity of surgery and improving the visual outcome in eyes with successfully reattached retinas.

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