Intravitreal air in aphakic retinal detachment.

The use ofintravitreal air, first mentioned by Arruga (I 936), is not popular in the treatment ofaphakic retinal detachments for two basic reasons: (I) The air may move the iris diaphragm forwards-causing an angle-block glaucoma. (2) The air itselfmay escape into the anterior chamber and remain there. The injection of air in cases of phakic retinal detachment is well known (Rosengren, I938), but sadly does not enjoy wide usage. My present phakic technique consists of monitored cryopexy to the retinal tears, release of subretinal fluid through a scratch sclerotomy, and injection of sterile air through the pars plana. A No. 40 silicone band may or may not be placed around the eye. The patient's posture after the operation is arranged in such away that the air presses the retinal tears upwards against the treated choroid. To use the technique successfully and to avoid an unpleasant position for the patient postoperatively, it should be used when the retinal tears lie between the 8 and the 4 o'clock meridians superiorly. In addition, the eye must be made sufficiently hypotonic to make room for the I and 3 ml. of air which is injected. This latter requirement is vital and the whole technique is described in detail in the following paper (Chawla and Birchall, I973). The present paper discusses eight patients who have suffered aphakic retinal detachment. All were treated with intravitreal air injection, monitored cryopexy, and an encircling No. 40 silicone band. An in-depth study of their lens extractions and subsequent detachments is not strictly relevant, since the main aim is to demonstrate and restate the tolerance of the aphakic eye to intravitreal air.