[The expanding gas operation after a 15-year use. Animal experiment studies, subsequent developments of the method and clinical results in the treatment of ablatio retinae]

Abstract

The expanding-gas-operation, a detachment surgery consisting in an intraocular (i.o.) injection of an expanding gas such as SF6 (without drainage and without vitrectomy) in combination with cryo or laser, was described by Kreissig in 1979. The method was used in the treatment of tears problematic for tamponading by extraocular (e.o.) plombages (giant tear, hole in posterior pole, scattered groups of breaks). With the introduction of the perfluorocarbon gases (CF4, C2F6, C3F8, C4F10) by Lincoff and his group in the beginning of the eighties the use of the gas-operation was improved: the expansion of the new gases ranged from 1.9x to 5x and their i.o. duration, defined as half time volume, from 6 to 45 days. However, animal experiments confirmed that an expanding i.o. gas bubble induces a break-down of the blood aqueous barrier, an increase of protein, an infiltration of cells into the vitreous and a compression of vitreous membranes against the retina implying the threat of subsequent proliferative vitreoretinopathy (PVR). The expanding-gas-operation is contraindicated in a detachment with PVR stage C and D. In spite of a recent renaissance of the expanding-gas-operation by Dominguez and Hilton in the middle of the eighties, the issue is still valid: in the treatment of a detachment an e.o. plombage is better than an i.o. gas bubble; this is especially pertinent for uncomplicated retinal detachments representing the indication of choice for a temporary e.o. plombage without drainage, the balloon-operation. As a consequence, at present the expanding-gas-operation is only justified for problematic retinal tears.(ABSTRACT TRUNCATED AT 250 WORDS)