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| ARTICLES |
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| Year : 1976 | Volume
: 24
| Issue : 4 | Page : 18-19 |
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Intravitreal injections in retinal detachment surgery
OP Ahuja
Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh, India
Correspondence Address:
O P Ahuja
Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 924614 
How to cite this article:
Ahuja O P. Intravitreal injections in retinal detachment surgery. Indian J Ophthalmol 1976;24:18-9 |
In addition to the classical surgical steps for the treatment of retinal detachment, various authors have described situations where intra-ocular injection of certain materials is advocated. Such a procedure has been indicated for one or the other reasons viz. to provide a hydraulic pressure for splinting the retina by expelling the sub-retinal fluid, to break vitreo-retinal adhesions ; to relax the traction of pre-retinal organisation; and in cases of giant tears with folded retina.
Some of the substances which have been employed are physiological saline,[2] liquid silicon[1],[4],[6] air, [3] hyaluronic acid[2] and sulfur hexafluoride.[5] The search is, however, still on to find out an ideal material which should have the properties of being sterile, non-irritating and non-toxic in long term, and which must remain effective in the eve for a sufficient length of time and still permit adequate penetration of nutrients in the posterior chamber.
| Material and Methods | |  |
This report describes our experience of intraocular injection of normal saline in 13 eyes (8 aphakic, 5 phakic) used for situations other than those described earlier. In all eyes, the basic procedure for the correction of retinal detachment consisted of a grooved, intra-scleral silicone implant with an encircling silicone tape. Drainage of subretinal fluid was done in all eyes. A decision to inject saline into the vitreous cavity was made in the following situations met with after completing the basic procedure mentioned.
1. Non-settlement of retina with low tension -6 eyes
2. Settled retina with low tension -2 eyes.
3, Settled retina with normal ocular tension but too high a buckle, with or without visible meridional folds. -5 eyes
| Technique of Injections | | |
In the supero-temporal quadrant, a 3.00 mm meridional incision is made in the sclera, the centre of the incision being 5.5 mm away from the limbus. After incising 3/4th scleral thickness a mattress suture placed in the lips. The incision is surrounded by a ring of non-perforating diathermy marks. The edges of the incision then retract exposing the deeper scleral fibres which are incised until ciliary body (Pars Plana) is reached. A 20-gauge needle on the loaded syringe is then introduced through the exposed parsplana and the suture is tightened with a single knot. The needle point is guided to a point a little behind the centre of the lens under direct vision through the indirect binocular ophthalmoscope, Saline is injected slowly until the ocular tension feels near normal. The needle is then withdrawn and the suture tied finally.
In the present series, the injection site was prepared before the release of subretinal fluid in 6 eyes and after it in 7. In the case of later group, ocular tension was built up by temporarily tightening the encircling band in order to facilitate the manoeuvre on the sclera. As the injection was made the ends of the tape were gradually released until the point of the desired buckling effect.
| Results | | |
The specific- objectives, for which the injection procedure had been undertaken, were achieved on the operation table in all the 13 eyes. In 6 eyes, the residual detachment after draining the sub retinal fluid was corrected and the eye was made normotensive. In 2 eyes where retina had settled, a normal ocular tension was achieved and in the group of 5 eyes with too high a buckle, this anomaly was corrected and meridional folds when present, were neutralized.
One eye was lost in the post-operative period because of an endophthalmitis. There was a recurrence of detachment in two more eyes, in. one after six weeks and in the other nine weeks after the operation. The recurrence in both these cases was assigned to the development of pre-retinal retraction.
| Comments | | |
Massive pre-retinal retraction is one of the commonest causes responsible for failures of operations for retinal detachment. This condition may be pre-existing or may develop after operation. Long lasting vitreous replacements are indicated to counteract the effects of fibrosis, in such cases.
Besides, we may confront certain situations where even a short-lasting and simple substance like normal saline may achieve the objectives as illustrated in the present series. In the beginning we used to decide the indication and prepare the injection site only after the release of sub-retinal fluid. At this stage, however, it is much more difficult to design the site of injection on the soft eyeball. Gradually, we learnt to anticipate the need for this procedure and prepared the site before releasing the sub retinul fluid In our experience the situations where the need for an intravitreal injection can be anticipated include a bullous detachment extending to 3/4 th or more of the retinal surface in an aphakic eye ; a total bullous detachment in phakic eyes, and a bullous detachment of any extent with already a hypotonic eye.
| Summary | | |
An intravitreal injection of normal saline was made in 13 eyes (8 aphakic, 5 phakic), as an adjunct to surgery for retinal detachment.
Details of the injection technique are described.
Indications for injection as decided on the operation table are described.
Certain situations are mentioned where the need for this procedure can be anticipated.
| References | | |
| 1. | Brockhurst, R.J., 1965, Controversial Aspects of the Management of Retinal Detachment ed. Schepens, C. L., Regan C.D.J., 111, J.& A. Churchill London.  |
| 2. | Edmund, J., 1974, Limitations and Prospects for Retinal Surgery ed. Norton, E. et al 370, S. Kerger, Bassel. |
| 3. | Machemer, R., Aaberg, T. M. and Norton E.W.D., 1969, Amer. J. Ophthal. 68, 1022. |
| 4. | Okun, E., 1968, Trans. Pac. Coast Oto. Ophthal. Soc., 49, 141. |
| 5. | Vygantas, C.M. and Peyman, G. A., 1973, Arch. Ophthal., 90, 235. |
| 6. | Watzke, R.C., 1967, Arch. Ophthal., 77, 185. |
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