Vitreous Substitutes from Bench to the Operating Room in a Translational Approach: Review and Future Endeavors in Vitreoretinal Surgery

Abstract

Vitreous substitutes are indispensable tools in vitreoretinal surgery. The two crucial functions of these substitutes are their ability to displace intravitreal fluid from the retinal surface and to allow the retina to adhere to the retinal pigment epithelium. Today, vitreoretinal surgeons can choose among a plethora of vitreous tamponades, and the tamponade of choice might be difficult to determine in the ever-expanding range of possibilities for a favorable outcome. The currently available vitreous substitutes have disadvantages that need to be addressed to improve the surgical outcome achievable today. Herein, the fundamental physical and chemical proprieties of all vitreous substitutes are reported, and their use and clinical applications are described alongside some surgical techniques of intra-operative manipulation. The major upcoming developments in vitreous substitutes are extensively discussed, keeping a translational perspective throughout. Conclusions on future perspectives are derived through an in-depth analysis of what is lacking today in terms of desired outcomes and biomaterials technology.

Silicone oil emulsification: A literature review and role of widefield imaging and ultra-widefield imaging with navigated central and peripheral optical coherence tomography technology

“…The indications for the use of SO have extended to include the treatment of several and complex pathologies such as ocular trauma, giant retinal tears, proliferative diabetic retinopathy, viral retinitis, and endophthalmitis, among others. [ 6 8 9 21 22 ] Moreover, the unique properties of SO have made it the most popular choice for long-term vitreous replacement in challenging cases.…”

“…However, PPV necessitates the intraoperative use of agents to fill the vitreous cavity as temporary tamponing ones or permanent vitreous substitutes. [ 6 ] Over time, a variety of vitreous substitutes have been developed and utilized during PPV, including balanced salt solution, air, gases, and silicone oil (SO). [ 6 7 ] Each of these substitutes possesses unique chemical and physical properties.…”

“…[ 6 ] Over time, a variety of vitreous substitutes have been developed and utilized during PPV, including balanced salt solution, air, gases, and silicone oil (SO). [ 6 7 ] Each of these substitutes possesses unique chemical and physical properties. [ 6 ] The diversity in available vitreous substitutes provides surgeons the flexibility to tailor the selection of the most appropriate intraocular tamponade based on the underlying condition, circumstances, and duration of tamponade required within the eye.…”

“…[ 6 7 ] Each of these substitutes possesses unique chemical and physical properties. [ 6 ] The diversity in available vitreous substitutes provides surgeons the flexibility to tailor the selection of the most appropriate intraocular tamponade based on the underlying condition, circumstances, and duration of tamponade required within the eye. [ 6 ] It is important to note that while each compound offers distinct advantages, they also may have specific disadvantages that can potentially lead to severe and irreversible adverse events.…”

“…[ 6 ] It is important to note that while each compound offers distinct advantages, they also may have specific disadvantages that can potentially lead to severe and irreversible adverse events. [ 6 ]…”