To the Editor.
—Drs Brown and Benson have reported the use of sodium hyaluronate (Healon) to unfold giant retinal tears.1 While I used this technique with success in the past, I would offer several words of caution. When the retina is somewhat stiffened from chronic detachment or proliferative vitreoretinopathy, the sodium hyaluronate can produce an impressive unfolding. Subsequently, during even gentle application of cryotherapy, however, the mild distortion of the globe can induce the retina to fold on itself again, forcing the sodiumhyaluronate anteriorly and then into the subretinal space where it is difficult to identify and remove. Due to low surface tension, it can also run through small retinal breaks or retinotomies into the subretinal space. Finally, we have seen significant elevations of intraocular pressure even in phakic eyes after the patient was thought to have had a complete supine sodium hyaluronate air exchange with postoperative face-down positioning.
Meredith TA. Giant Retinal Tears. Arch Ophthalmol. 1990;108(6):777. doi:10.1001/archopht.1990.01070080019003