Intraoperative adjunctive agents in vitrectomy: serum, cytokines, and glue

The surgical goal in the treatment of retinal breaks is to seal the edges of the break, and traditionally, photocoagulation and cryocoagulation have been used to accomplish this. However, it is sometimes difficult in complicated retinal detachments to maintain the seal against tractional forces. Adhesion is achieved through a process of cell necrosis, inflammation and subsequent fibrovascular proliferation. This strategy, however, may not be appropriate in vision-sensitive areas such as macular holes. To improve the success rate of macular hole surgery, a number of authors have advocated the use of biological modifiers, such as transforming growth factor beta, human autologous serum, tissue glue, or platelet concentrates. These materials may enhance the adhesion of the detached retina and therefore lead to a better anatomical and functional success. We have reviewed the advances of intraoperative application of synthetic or biological adhesives. However, through the improvement of surgical techniques and surgeons' skills in recent years, the anatomical success rate of macular hole surgery has increased in most institutions without adjunctive additives. Thus, many surgeons believe that adjunctive additives may not be necessary for most idiopathic macular holes.