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Vision or Madness? Primary vitrectomy without gas tamponade

  • Bernd Kirchhof
Editorial (by Invitation)

Wilson Heriot, vitreo-retinal surgeon from Melbourne, continues to elaborate the concept of primary vitrectomy without gas. To obviate gas will not secure from proliferative vitreoretinopathy (PVR). But it would facilitate air travel, supersede positioning, and avoid secondary cataracts and glaucoma. Following the pioneering reports of Martinez-Castillo [1], Dr. Heriot refines the technique for a retino-choroidal seal by actively drying the retina around the hole prior to the application of laser burns. In 2014 Dr. Heriot filed a patent on how to optimally dry reattached peripheral retina in an air filled eye (AU2014207245). He presents histological evidence that retina and choroid can be fused through light energy, but only in the absence of subretinal fluid. Vitreo-retinal surgeons are coined to set safety first, humbled by the fact that failed retinal reattachment funnels into PVR. The evidence so far is in-sufficient to bid farewell to gas. But it is sufficient to be communicated and to pursue further investigations: Is the seal of the subretinal space adequate, not only in terms of morphology but also by means of mechanical strength? Yoon and Marmor [2] reported 1988 that laserburns compromise the adhesive force by 50 % up to 8 h. Eventually a prospective randomised study against the gas filled eye is inevitable to test the hypothesis, like the SPR-Study [3] tested primary vitrectomy against buckling. The re-attachment rate of 72-79 % (phakic-pseudophakic) is up to be beaten. Dr. Heriot considers himself to be “mad”, according to a 2014 interview with the “Centre for Eye Research Australia” [4]. But after all it may be so, that the circumvention of a gas tamponade fosters persistent retinal re-attachment and reduces the risk of PVR, since gas aggravates blood-ocular barrier breakdown [5].

References

  1. 1.
    Martínez-Castillo V, Zapata M, Boixadera A, Fonollosa A, García-Arumí J (2007) Pars plana vitrectomy, laser retinopexy, and aqueous tamponade for pseudophakic rhegmatogenous retinal detachment. Ophthalmology 114(2):297–302CrossRefPubMedGoogle Scholar
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    Yoon YH, Marmor MF (1988) Rapid enhancement of retinal adhesion by laser photocoagulation. Ophthalmology 95(10):1385–1388CrossRefPubMedGoogle Scholar
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    Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers RD, Foerster MH; Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group (2007) Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology 114(12):2142–2154CrossRefGoogle Scholar
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    Ogura Y, Tsukada T, Negi A, Honda Y (1989) Integrity of the blood-ocular barrier after intravitreal gas injection. Retina 9(3):199–202CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.University of CologneCologneGermany

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