Background <p>The human vitreous body plays an important role in intraocular homeostasis and fulfils structural, metabolic and immunological functions. In the context of vitreoretinal surgery artificial endotamponades are introduced to stabilize the retina.</p> Objective <p>Clinically established endotamponades, their applications, advantages and disadvantages, the distinction from total vitreous body replacement and the development of hydrophilic vitreous body substitutes are presented. The current state of development and the potential of synthetic hydrogels as vitreous body substitutes are analyzed.</p> Material and methods <p>Discussion of the basic literature and review articles on surgical endotamponades and hydrogel-based vitreous body substitutes.</p> Results <p>All established endotamponades exert a&#xa0;local stabilizing function through the principle of buoyancy or counterbuoyancy combined with surface tension and show disadvantages for the patient. Vitreous body substitutes, which can fully replace the physiological functions of the natural vitreous body, must be distinguished from endotamponades. The development of hydrogels has progressed through four generations, each offering promising approaches.</p> Conclusion <p>There are promising solutions involving synthetic hydrogels that could undertake and even expand the physiological role of the vitreous body as vitreous body substitutes, thereby improving therapeutic outcomes and patient satisfaction.</p>