EURETINA 2026: Kreissig Award Lecture weighs the evidence on tamponade choice in retinal detachment repair

At the 26th EURETINA Congress in Vienna, Austria, David Steel, a retinal specialist and surgeon in the north-east of England, delivered the Kreissig Award Lecture, titled “Optimising Tamponades to Repair Rhegmatogenous Retinal Detachment.” Speaking with Ophthalmology Times Europe, Steel explained that the lecture fell into 2 halves: the evidence on the best tamponade for various scenarios in retinal detachment surgery, and an overview of novel tamponade agents.

Registry data where trials fall short

Steel drew on data from the vitreoretinal outcomes database started by BEAVRS and EURETINA. He noted that although randomised controlled trials (RCTs) are the gold-standard evidence for these questions, they are difficult to conduct because of time and cost, and procedures with small effect sizes are difficult to power adequately with RCTs.

Gas vs silicone oil

In cases where either oil or gas could be used, the database showed no great anatomical differences between gases and oil overall. However, C2F6 gas appeared to offer anatomical advantages over both C3F8 and oil. Visually, both gases outperformed oil, with C2F6 holding a marginal advantage over C3F8.

Heavy vs light silicone oil

When oil is the chosen tamponade, heavy oil offered an advantage over light oil, with a doubling of the odds of surgical success and a mean visual advantage of 15 letters, with a minimum advantage of 5 letters. The heavy oil cases were confined to Densiron, because few cases in the database used Oxane HD.

Choosing a gas

Comparing gases, Steel reported that C2F6 may offer some advantages over SF6 and C3F8 in both average-complexity and slightly more complex cases. The effect sizes were relatively small, but the advantage applied to both anatomical and visual outcomes.

Steel suggested that this raises the question of an optimum tamponade duration. He cited a recent silicone oil study that compared 8 weeks with 16 weeks of tamponade and found visual advantages with the shorter duration. “So there may be a sweet spot of tamponade duration, which C2F6 hits,” he said.

Novel agents on the horizon

The second half of the lecture covered new approaches. Steel described a novel heavy tamponade with the same refractive index as vitreous, low viscosity and a higher specific gravity than Densiron, with a strong suggestion that it emulsifies far less. Surgeons could use it as an intraoperative tool and leave it in as a postoperative tamponade, reducing the length of surgery and the need for tamponade exchanges.

He also discussed volumetric vitreous replacements—essentially hydrogels—and their potential as slow-release devices for drug delivery, cellular delivery and advanced therapies targeting specific parts of the retina. Finally, he covered retinal patches, which work without tamponade, and thermofusion, which achieves instant retinal bonding around a break once the break is completely dry.

Key takeaways

Steel emphasised that surgeons have access to “a range of tamponades, and they’ve all got different merits,” and should carefully consider which to use in individual cases to optimise outcomes for patients. He added that several new agents on the horizon may offer further advantages.