Aim: To demonstrate the influence of intraocular fluid-air exchange on retinal ganglion cell activity. Methods: In two cats lensectomy and vitrectomy were performed in a two-step approach 2 weeks prior to recording experiments. To measure retinal activity, up to two fiber microelectrodes were inserted via a scleral port. Precise micromanipulator positioning of the electrodes’ tips onto the inner retinal surface were verified by ophthalmoscopy and simultaneous electrical recording. Neuronal activity of the retina was continuously recorded with or without visual stimulation. We maintained the intraocular pressure constant at 29 mm Hg. Fluid-air exchange and fluid refill were performed with an infusion tube integrated in the manipulator and slowly to avoid direct mechanical/stream-based damage of the retina. Results: We found that fluid-air exchange leads to a rapid reduction of spontaneous as well as visually evoked retinal ganglion cell activity. The activity started to diminish within few minutes, and then it halved approximately every 3 min. Even 1 h after eye fluid refill, the retinal activity recovered only partially. Conclusion: Decrease in retinal activity after fluid-air exchange can be explained by mechanical stress-induced drying of the inner retinal surface and by potential changes of extracellular ion concentration. Since even moderate airstream-based fluid-air exchanges can lead to retinal damage, the surgeon should minimize the quantity of air passing open sclerotomy sites until a better understanding of the retinal effects of this essential technique in modern vitrectomy is available.

1.
Boldt HC, Munden PM, Folk JC, Mehaffey MG: Visual field defects after macular hole surgery. Am J Ophthalmol 1996;122:371–381.
2.
Bopp S, Lucke K, Hille U: Peripheral visual field loss after vitreous surgery for macular holes. Graefes Arch Clin Exp Ophthalmol 1997;235:362–371.
3.
Cullinane AB, Cleary PE: Prevention of viusal field defect after macular hole surgery. Br J Ophthalmol 2000;84:372–377.
4.
Ezra E, Arden GB, Riordan-Eva P, Aylward GW, Gregor ZJ: Visual field loss following vitrectomy for stage 2 and 3 macular holes. Br J Ophthalmol 1996;80:519–552.
5.
Hasumura T, Yonemura N, Hirata A, Murata Y, Negi A: Retinal damage by air infusion during vitrectomy in rabbit eyes. Invest Ophthalmol Vis Sci 2000;41:4300–4304.
6.
Hirata A, Yonemura N, Hasumura T, Murata Y, Negi A: Effect of infusion air pressure on visual field defects after macular hole surgery. Am J Ophthalmol 2000;130:611–616.
7.
Hirokazu O, Kasuga Y, Hata N, Manabe S, Yasuyuki T, Lee S, Yamakawa R: Morphological changes in the optic disc after vitrectomy and fluid-air exchange. Graefes Arch Clin Exp Ophthal 2004;242:484–488.
8.
Hutton WL, Fuller DG, Snyder WB, Fellman RL, Swanson WH: Visual field defects after macular hole surgery. A new finding. Ophthalmology 1996;103:2152–2158.
9.
Kerrison JB, Haller JA, Elman M, Miller NR: Visual field loss following vitreous surgery. Arch Ophthalmol 1996;114:564–569.
10.
Malinowski SM, Pesin SR: Visual field loss caused by retinal vascular occlusion after vitrectomy surgery. Am J Ophthalmol 1997;123:707–708.
11.
Melberg NS, Thomas MA: Visual field loss after pars plana vitrectomy with air/fluid exchange. Am J Ophthalmol 1995;120:386–388.
12.
Ohji M, Nao IN, Saito Y, Hayashi A, Tano Y: Prevention of visual field defect after macular hole surgery by passing air used for fluid-air exchange through water. Am J Ophthalmol 1999;127:62–66.
13.
Paques M, Massin P, Santiago PY, Spielmann AC, Gaudric A: Visual field loss after vitrectomy for full-thickness macular holes. Am J Ophthalmol 1997;124:88–94.
14.
Takenaka H, Maeno T, Mano T, Misuda H: Causes of visual field defects after vitrectomy. Nippon Ganka Gakkai Zasshi 1999;103:399–403.
15.
Welch JC: Dehydration injury as a possible cause of visual field defect after pars plana vitrectomy for macular hole. Am J Ophthalmol 1997;124:698–699.
16.
Yonemura N, Hirata A, Hasumura T, Negi A: Long-term alteration in the air-infused rabbit retina. Graefes Arch Clin Exp Ophthalmol 2003;241:314–320.
17.
Yonemura N, Hirata A, Hasumura T, Negi A: Fundus changes corresponding to visual field defects after vitrectomy for macular hole. Ophthalmology 2001;108:1638–1643.
18.
Ohashi H, Kasuga Y, Hata N, Manabe S, Takashima Y, Lee S, Yamakawa R: Morphological changes in the optic disc after vitrectomy and fluid-air exchange. Graefes Arch Clin Exp Ophthalmol 2004;242:484–488.
19.
Schanze T, Wilms M, Eger M, Hesse L, Eckhorn R: Activation zones in cat visual cortex evoked by electrical retina stimulation. Graefe’s Arch Clin Exp Ophthalmol 2002;240:947–954.
20.
Schanze T, Greve N, Hesse L: Towards the cortical representation of form and motion stimuli generated by a retina implant. Graefe’s Arch Clin Exp Ophthalmol 2003;241:685–693.
21.
Winter M, Eberhardt W, Scholz C, Reichenbach A: Failure of potassium siphoning by Müller cells: a new hypothesis of perfluorocarbon liquid-induced retinopathy. Invest Ophthalmol Vis Sci 2000;41:256–261.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.