Abstract
Human vitreous is a natural intraocular polymeric hydrogel with distinct biochemical and physiological functions. Surgical removal of the vitreous, or vitrectomy, is now commonly performed for the treatment of many vitreoretinal diseases. This has led to the need for developing substances that can be used to replace vitreous. Although early attempts for vitreous transplantation have yielded little success [1], a range of other vitreous substitutes has been developed. An ideal substitute should have all the good qualities of the human vitreous, including transparency, elasticity, buffer capacity, and biocompatibility with surrounding ocular tissues. However, none of the currently available vitreous substitutes possesses all these qualities. In modern vitreoretinal surgery, both short-acting (e.g., air, balanced salt solutions, expansile gases) and long-acting vitreous substitutes (e.g., silicone oil) are used. All these substitutes have significant shortcomings, mostly related to the lack of local biocompatibility and inadequate physiological role. In this chapter, we discuss the biophysical, biochemical, and physiological properties of the available vitreous substitutes, as well as their clinical use, advantages, and limitations. A separate chapter addresses the future potential of an artificial vitreous [see chapter I.F. Vitreous biochemistry and artificial vitreous].
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References
Offret G, Pouliquen Y, Haut J. Transplantation of fresh vitreous humor as a treatment of posterior uveitis. Bull Soc Ophtalmol Fr. 1968;68(1):23–7.
Benson WE, Diamond JG, Tasman W. Intraocular irrigating solutions for pars plana vitrectomy. A prospective, randomized, double-blind study. Arch Ophthalmol. 1981;99(6):1013–5.
Matsuda M, Tano Y, Edelhauser HF. Comparison of intraocular irrigating solutions used for pars plana vitrectomy and prevention of endothelial cell loss. Jpn J Ophthalmol. 1984;28(3):230–8.
de Bustros S, Glaser BM, Johnson MA. Thrombin infusion for the control of intraocular bleeding during vitreous surgery. Arch Ophthalmol. 1985;103(6):837–9.
Asaria RH, Kon CH, Bunce C, et al. Adjuvant 5-fluorouracil and heparin prevents proliferative vitreoretinopathy: results from a randomized, double-blind, controlled clinical trial. Ophthalmology. 2001;108(7):1179–83.
Rosengren B. Results of treatment of detachment of the retina with diathermy and injection of air into the vitreous. Acta Ophthalmol. 1938;16:573–9.
Norton EW, Aaberg T, Fung W, Curtin VT. Giant retinal tears. I. Clinical management with intravitreal air. Am J Ophthalmol. 1969;68(6):1011–21.
Hilton GF, Grizzard WS. Pneumatic retinopexy. A two-step outpatient operation without conjunctival incision. Ophthalmology. 1986;93(5):626–41.
Sebag J, Tang M. Pneumatic retinopexy using only air. Retina. 1993;13(1):8–12.
Yee KM, Sebag J. Long-term results of office-based pneumatic retinopexy using pure air. Br J Ophthalmol. 2011;95(12):1728–30.
Machemer R, Buettner H, Norton EW, Parel JM. Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol. 1971;75(4):813–20.
Lincoff A, Lincoff H, Iwamoto T, Jacobiec F, Kreissig I. Perfluoro-n-butane. A gas for a maximum duration retinal tamponade. Arch Ophthalmol. 1983;101(3):460–2.
Lincoff A, Lincoff H, Solorzano C, Iwamoto T. Selection of xenon gas for rapidly disappearing retinal tamponade. Arch Ophthalmol. 1982;100(6):996–7.
Vygantas CM, Peyman GA, Daily MJ, Ericson ES. Octafluorocyclobutane and other gases for vitreous replacement. Arch Ophthalmol. 1973;90(3):235–6.
Killey FP, Edelhauser HF, Aaberg TM. Intraocular sulfur hexafluoride and octofluorocyclobutane. Effects on intraocular pressure and vitreous volume. Arch Ophthalmol. 1978;96(3):511–5.
Stanford MR, Chignell AH. Surgical treatment of superior bullous rhegmatogenous retinal detachments. Br J Ophthalmol. 1985;69(10):729–32.
Gilbert C, McLeod D. D-ACE surgical sequence for selected bullous retinal detachments. Br J Ophthalmol. 1985;69(10):733–6.
Tornambe PE. Pneumatic retinopexy: the evolution of case selection and surgical technique. A twelve-year study of 302 eyes. Trans Am Ophthalmol Soc. 1997;95:551–78.
Hilton GF, Tornambe PE. Pneumatic retinopexy. An analysis of intraoperative and postoperative complications. The Retinal Detachment Study Group. Retina. 1991;11(3):285–94.
Sharma A, Grigoropoulos V, Williamson TH. Management of primary rhegmatogenous retinal detachment with inferior breaks. Br J Ophthalmol. 2004;88(11):1372–5.
McCuen 2nd BW, Azen SP, Stern W, et al. Vitrectomy with silicone oil or perfluoropropane gas in eyes with severe proliferative vitreoretinopathy. Silicone Study Report 3. Retina. 1993;13(4):279–84.
Chang S. Intraocular gases. In: Ryan SJ, editor. Retina. 4th ed. Philadelphia: Elsevier; 2006.
Fawcett IM, Williams RL, Wong D. Contact angles of substances used for internal tamponade in retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol. 1994;232(7):438–44.
Charles S. Vitreous surgery. 2nd ed. Williams & Wilkins: Baltimore; 1987.
van Meurs JC, Humalda D, Mertens DA, Peperkamp E. Retinal folds through the macula. Doc Ophthalmol. 1991;78(3–4):335–40.
Hilton GF, Kelly NE, Salzano TC, Tornambe PE, Wells JW, Wendel RT. Pneumatic retinopexy. A collaborative report of the first 100 cases. Ophthalmology. 1987;94(4):307–14.
Crittenden JJ, De Juan Jr E, Tiedeman J. Expansion of long-acting gas bubbles for intraocular use. Principles and practice. Arch Ophthalmol. 1985;103(6):831–4.
Peters MA, Abrams GW, Hamilton LH, Burke JM, Schrieber TM. The nonexpansile, equilibrated concentration of perfluoropropane gas in the eye. Am J Ophthalmol. 1985;100(6):831–9.
Thompson JT. Kinetics of intraocular gases. Disappearance of air, sulfur hexafluoride, and perfluoropropane after pars plana vitrectomy. Arch Ophthalmol. 1989;107(5):687–91.
Wolf GL, Capuano C, Hartung J. Nitrous oxide increases intraocular pressure after intravitreal sulfur hexafluoride injection. Anesthesiology. 1983;59(6):547–8.
Seaberg RR, Freeman WR, Goldbaum MH, Manecke Jr GR. Permanent postoperative vision loss associated with expansion of intraocular gas in the presence of a nitrous oxide-containing anesthetic. Anesthesiology. 2002;97(5):1309–10.
Fu AD, McDonald HR, Eliott D, et al. Complications of general anesthesia using nitrous oxide in eyes with preexisting gas bubbles. Retina. 2002;22(5):569–74.
Lincoff H, Weinberger D, Stergiu P. Air travel with intraocular gas. II. Clinical considerations. Arch Ophthalmol. 1989;107(6):907–10.
Norton EWD, Fuller DG. The use of intraocular sulfur hexafluoride in vitrectomy. In: Irvine AR, O’Malley C, editors. Advances in vitreous surgery. Springfield: Charles C Thomas; 1976.
Brubaker RF. Flow of aqueous humor in humans [The Friedenwald Lecture]. Invest Ophthalmol Vis Sci. 1991;32(13):3145–66.
Levasseur SD, Rahhal FM. Travel to high mountain elevations following vitrectomy with intraocular gas. Retina. 2013;33(7):1456–61.
Jackman SV, Thompson JT. Effects of hyperbaric exposure on eyes with intraocular gas bubbles. Retina. 1995;15(2):160–6.
Drury B, Bourke RD. Short-term intraocular tamponade with perfluorocarbon heavy liquid. Br J Ophthalmol. 2011;95(5):694–8.
Rush R, Sheth S, Surka S, Ho I, Gregory-Roberts J. Postoperative perfluoro-N-octane tamponade for primary retinal detachment repair. Retina. 2012;32(6):1114–20.
Sigler EJ, Randolph JC, Calzada JI, Charles S. 25-gauge pars plana vitrectomy with medium-term postoperative perfluoro-n-octane tamponade for inferior retinal detachment. Ophthalmic Surg Lasers Imaging Retina. 2013;44(1):34–40.
Clark Jr LC, Gollan F. Survival of mammals breathing organic liquids equilibrated with oxygen at atmospheric pressure. Science. 1966;152(3730):1755–6.
Geyer RP. Fluorocarbon-polyol artificial blood substitutes. N Engl J Med. 1973;289(20):1077–82.
Chang TM, Farmer M, Geyer RP, Moss G. Blood substitutes based on modified hemoglobin and fluorochemicals. ASAIO Trans. 1987;33(4):819–23.
Chang S. Low viscosity liquid fluorochemicals in vitreous surgery. Am J Ophthalmol. 1987;103(1):38–43.
Chang S, Ozmert E, Zimmerman NJ. Intraoperative perfluorocarbon liquids in the management of proliferative vitreoretinopathy. Am J Ophthalmol. 1988;106(6):668–74.
Bourke RD, Simpson RN, Cooling RJ, Sparrow JR. The stability of perfluoro-N-octane during vitreoretinal procedures. Arch Ophthalmol. 1996;114(5):537–44.
Sparrow JR, Matthews GP, Iwamoto T, Ross R, Gershbein A, Chang S. Retinal tolerance to intravitreal perfluoromethylcyclohexane liquid in the rabbit. Retina. 1993;13(1):56–62.
Azzolini C, Brancato R, Trabucchi G, Camesasca F, Codenotti M, Verdi M. Endophotocoagulation through perfluorodecalin in rabbit eyes. Int Ophthalmol. 1994;18(1):33–6.
Berglin L, Ren J, Algvere PV. Retinal detachment and degeneration in response to subretinal perfluorodecalin in rabbit eyes. Graefes Arch Clin Exp Ophthalmol. 1993;231(4):233–7.
Conway MD, Peyman GA, Karacorlu M, et al. Perfluorooctylbromide (PFOB) as a vitreous substitute in non-human primates. Int Ophthalmol. 1993;17(5):259–64.
Batman C, Cekic O. Effects of the long-term use of perfluoroperhydrophenanthrene on the retina. Ophthalmic Surg Lasers. 1998;29(2):144–6.
Chang S, Zimmerman NJ, Iwamoto T, Ortiz R, Faris D. Experimental vitreous replacement with perfluorotributylamine. Am J Ophthalmol. 1987;103(1):29–37.
Bryan JS, Friedman SM, Mames RN, Margo CE. Experimental vitreous replacement with perfluorotri-n-propylamine. Arch Ophthalmol. 1994;112(8):1098–102.
Winter M, Eberhardt W, Scholz C, Reichenbach A. Failure of potassium siphoning by Muller cells: a new hypothesis of perfluorocarbon liquid-induced retinopathy. Invest Ophthalmol Vis Sci. 2000;41(1):256–61.
Grey RHB, Leaver P. Results of silicone oil injection in massive preretinal retraction. Trans Ophthalmol Soc UK. 1977;97:238–41.
Grey RHB, Leaver P. Silicone oil in the treatment of massive preretinal retraction: I Results in 105 eyes. Br J Ophthalmol. 1979;63:345–50.
Haut J, Ullern M, Chermet M, et al. Complications of intraocular injections of silicone combined with vitrectomy. Ophthalmologica. 1980;180:29–35.
Leaver PK, Cooling R, Feretis EB, et al. Vitrectomy and fluid/silicone exchange for giant retinal tears: results at six months. Br J Ophthalmol. 1984;227:323–7.
Leaver PK, Garner A, Grey RHB. Effects of intraocular silicone oil. Trans Ophthalmol Soc UK. 1977;97:633.
Leaver PK, Grey R, Garner A. Complications following silicone oil injection. Mod Probl Ophthalmol. 1979;20:290–4.
Proliferative vitreoretinopathy. The Silicone Study Group. Am J Ophthalmol. 1985;99(5):593–595.
Azen SP, Boone DC, Barlow W, et al. Methods, statistical features, and baseline results of a standardized, multicentered ophthalmologic surgical trial: the Silicone Study. Control Clin Trials. 1991;12(3):438–55.
Wolf S, Schon V, Meier P, Wiedemann P. Silicone oil-RMN3 mixture (“heavy silicone oil”) as internal tamponade for complicated retinal detachment. Retina. 2003;23(3):335–42.
Stolba U, Krepler K, Velikay-Parel M, Binder S. The effect of specific gravity of perfluorocarbon liquid on the retina after experimental vitreous substitution. Graefes Arch Clin Exp Ophthalmol. 2004;242(11):931–6.
Velikay M, Wedrich A, Stolba U, Datlinger P, Li Y, Binder S. Experimental long-term vitreous replacement with purified and nonpurified perfluorodecalin. Am J Ophthalmol. 1993;116(5):565–70.
Gonvers M, Hornung JP, de Courten C. The effect of liquid silicone on the rabbit retina. Histologic and ultrastructural study. Arch Ophthalmol. 1986;104(7):1057–62.
Eckardt C, Nicolai U, Winter M, Knop E. Experimental intraocular tolerance to liquid perfluorooctane and perfluoropolyether. Retina. 1991;11(4):375–84.
Wong D, Williams R, Stappler T, Groenewald C. What pressure is exerted on the retina by heavy tamponade agents? Graefes Arch Clin Exp Ophthalmol. 2005;243(5):474–7.
Mackiewicz J, Maaijwee K, Luke C, et al. Effect of gravity in long-term vitreous tamponade: in vivo investigation using perfluorocarbon liquids and semi-fluorinated alkanes. Graefes Arch Clin Exp Ophthalmol. 2007;245(5):665–75.
Doi M, Refojo M. Histopatology of rabbit eyes with intravitreous silicone-fluorosilicone copolymer oil. Exp Eye Res. 1994;59(6):737–46.
Parver LM, Lincoff H. Geometry of intraocular gas used in retinal surgery. Mod Probl Ophthalmol. 1977;18:338–43.
Parver LM, Lincoff H. Mechanics of intraocular gas. Invest Ophthalmol Vis Sci. 1978;17(1):77–9.
Feynman RP, Leighton R, Sands M. The Feynman lectures on physics. In: Feynman RP, Leighton R, Sands M, editors. The Feynman lectures on physics. Addison-Wesley; Boston. 1972.
Laqua H, Lucke K, Foerster M. Results of silicone oil surgery. Jpn J Ophthalmol. 1987;31(1):124–31.
Crisp A, De Juan Jr E, Tiedeman J. Effect of silicone oil viscosity on emulsification. Arch Ophthalmol. 1987;105(4):546–50.
Steinhaus B, Shen A, Sureshkumar R. Dynamics of viscoelastic fluid filaments in microfluidic devices. Phys Fluids. 2007;19:1–13.
Williams RL, Day M, Garvey MJ, English R, Wong D. Increasing the extensional viscosity of silicone oil reduces the tendency for emulsification. Retina. 2010;30(2):300–4.
Stappler T, Williams R, Gibran SK, Liazos E, Wong D. A guide to the removal of heavy silicone oil. Br J Ophthalmol. 2008;92(6):844–7.
Romano MR, Groenwald C, Das R, Stappler T, Wong D, Heimann H. Removal of Densiron-68 with a 23-gauge transconjunctival vitrectomy system. Eye (Lond). 2009;23(3):715–7.
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Wong, I.Y., Cheung, N., Wong, D. (2014). IV.G. Physiology of Vitreous Substitutes. In: Sebag, J. (eds) Vitreous. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1086-1_31
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DOI: https://doi.org/10.1007/978-1-4939-1086-1_31
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