Hi, I'm David Steel. I'm a retinal surgeon and a clinical academic. I work in Northern England. I had the great honor of being awarded the Ingrid Kreissig award at this year's Euretina Meeting, which is where I'm at at the moment. This is an award that recognizes my contribution to retinal research over my career. So it's a great honor to present it in the presence of Ingrid Kreissig herself in the audience. The talk was on tamponades for retinal detachment repair with vitrectomy. First of all, in my talk, I presented results on several comparisons. First of all, the common dilemma, whether you should use oil or gas in a retinal detachment. Then I also considered the use of heavy oil versus light oil for particularly inferior detachments with inferior PVR. Then I also finally looked at the question of which gas to use if you're going to use a gas.

And to summarize my results, we found some interesting things. We found that if you compare oil to gases, you find that gases give significantly improved visual results in cases where you could use both tamponade agents. And interestingly, we also found a difference between C2F6 and C3F8, with generally C2F6 giving better results for both anatomical outcomes and visual outcomes. And then we looked at in cases with oil usage and inferior detachments comparing heavy to light oil, we found that denser on, so heavy oil, gave better results in those cases with inferior breaks and inferior PVR. And for the gases comparison, again, we were surprised to find that overall for both anatomical and visual outcomes, there were advantages to using C2F6, including some safety outcomes such as postoperative intraocular pressurize and cystoid macular edema. So they were unexpected, but question whether there is an optimum tamponade duration for retinal tamponade and detachments.

So there's evidence emerging that, for example, short-term tamponade with oil, so eight weeks compared to 16 weeks, gives improved results. And we postulated that the tamponade with C2F6 gives better results because it reaches a sweet spot on how long retinal tamponade should optimally be present for. I then moved on in my talk to introduce a number of options for new tamponade agents. So we talked about a heavier than water tamponade, which is in development called vitreodense, which is very interesting because it combines, instead of F6H8, which is combined with silicon oil and denseron, it combines F4H5, which is another PFAS substance, but it's got higher solubility in oil. So you can titrate its concentration oil to much greater degrees than F6H8. And so you can produce oils which have got the same refractive index as water. So you can imagine a tamponade which didn't alter refraction.

And also you can make the specific gravity higher. So you can get specific gravities of 1.2, which will mean that you could use it as a peripheral carbon replacement because it's got a low viscosity. So instead of having to use PSCLs during surgery, then remove it to have a long-term tamponade for postoperatively, you could just put vitreotents in the cavity, do the laser, do the surgery, and then leave it in postoperatively and then remove it later. And they also talked about the possibility of vitreous substitutions using hydrogels, which might enable, again, sustained drug delivery as well as targeted therapies using technologies such as silicon oxide, nanopropellers, as well as cellular treatments, because these hydrogels are missable with cellular therapies. And then we finally, I finished on talking about the hope that we might one day be able to repair retinal breaks with retinal patches. So in other words, doing a vitrectomy, putting the retina back in condition with air, and then doing laser and then using a patch of localized hydrogel just to cover the break rather than filling the vitreous cavity with a tamponade.

And then finally, the subject of possibly repairing detached retinas or sealing breaks with thermofusion, which is using technologies which Wilson Herriot from Australia has developed where the break is completely dried. And if you do laser to a break, which is in completely attached retina without subretinal fluid, you can get immediate bonding of the retina to the RPE, then you won't need a tamponade. So you'll be able to dry the break, do thermofusion, and then no tamponade will be needed. And again, that's going through trials at the moment and we look forward to seeing if that's going to be as good as we hope it's going to be. So that summarizes my talk. I hope the audience enjoyed it and thank you very much for listening.