Complications Associated with the Use of Expandable Gases in Vitrectomy

Abstract

Intraocular gases have been used in vitreoretinal surgery for over 40 years. The aim of this study was to review the complications related to the use of expandable gases in vitrectomy and their management. A PubMed, Cochrane Library, and Embase search was conducted using the terms “intraocular gas” and “vitrectomy for retinal detachment.” Of the articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Intraocular pressure elevation was reported in up to 58.9% patients after vitrectomy with expandable gas administration for retinal detachment. Vitreoretinal surgery is known to induce cataract development. With that, cataract progression is associated with lens exposure to intraocular gas, the duration of such exposure, patient's age, and the magnitude of vitreous removal. With intraocular gas, the posterior surface of the lens becomes a strongly refractive factor, resulting in high myopia and temporary vision impairment. Other complications related to the use of expandable gases include anterior chamber and subconjunctival gas displacement. Single reports on subretinal and cranial gas migration were published. In vitrectomy for uncomplicated retinal detachments, attempts to shift from expandable gases towards air are observed. Nevertheless, gas tamponade remains a reasonable choice for patients suffering from retinal detachment.

The Effectiveness of the Supine Position in Managing Inferior Breaks in Rhegmatogenous Retinal Detachment After Vitrectomy with Gas Tamponade

“…The risk factors included high gas concentrations, advanced patient age, and concomitant circumferential scleral buckling. 23 The rate of increase in IOP was low, and the increase occurred in the early days post-vitrectomy. This was controllable using topical antihypertensive medications.…”

“…Different rates of cataract progression (18.8%–51.8%) have been reported, 21 , 22 which may be due to the increase in retrolental oxygen levels and the inhibition of the diffusion of nutrients impeding lens metabolism. 23 The risk factors include the duration of the exposure of the lens to gas, the patient’s age, and the magnitude of the vitreous removal. It has been suggested that patients should avoid the supine position to decrease the contact between the lens and the gas.…”

Vitreoretinal surgery tip and tricks in the era of COVID-19

“…The choice of the endotamponade preferring air and silicon oil in eligible cases could minimize the number of follow-up visits required. Specifically, air is nowadays considered effective as gas tamponade in macular hole, pucker, and even in some retinal detachment surgeries, with less risks of intraocular pressure elevation in the postoperative course (that may require additional visits) [9,10].…”

Bioinspired Thermosensitive Hydrogel as a Vitreous Substitute: Synthesis, Properties, and Progress of Animal Studies

“…During or after vitrectomy, a vitreous substitute is needed to reattach or hold the retina in place. Currently used vitreous substitutes include silicone oil [3,4], saline buffers [5], expansible gases [6], and perfluorocarbons [7]. Each of these substitutes, however, comes with limitations and is associated with complications, such as emulsification for silicone oils, expansion of gases at high altitudes, and toxicity of perfluorocarbons.…”