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Biocompatibility of intraocular liquid tamponade agents: an update. Eye (Lond) 2021; 35:2699-2713. [PMID: 34035489 PMCID: PMC8452761 DOI: 10.1038/s41433-021-01596-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/04/2023] Open
Abstract
Intraocular liquids tamponade agents, such as perfluorocarbon liquids (PFCLs), semifluorinated alkanes (SFAs), silicone oils (SOs) and heavy silicone oils (HSOs), are a crucial intraoperative and/or postoperative tool in vitreoretinal surgery, in particular for the management of complex vitreoretinal diseases. However, their use is not without complications, which are potentially severe. Consequently, a growing interest has been devoted to the biocompatibility of these compounds and the adequacy of current regulations that should guarantee their safety. Obviously, an updated knowledge on research findings and potential risks associated to the use of intraocular liquid compounds is essential, not only for vitreoretinal surgeons, but also for any ophthalmologist involved in the management of patients receiving intraocular liquid tamponades. In light of this, the review provides a comprehensive characterisation of intraocular liquid tamponades, in terms of physical and chemical properties, current clinical use and possible complications. Moreover, this review focuses on the safety profile of these compounds, summarising the existing regulation and the available evidence on their biocompatibility.
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Baker AEG, Cui H, Ballios BG, Ing S, Yan P, Wolfer J, Wright T, Dang M, Gan NY, Cooke MJ, Ortín-Martínez A, Wallace VA, van der Kooy D, Devenyi R, Shoichet MS. Stable oxime-crosslinked hyaluronan-based hydrogel as a biomimetic vitreous substitute. Biomaterials 2021; 271:120750. [PMID: 33725584 DOI: 10.1016/j.biomaterials.2021.120750] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
Vitreous substitutes are clinically used to maintain retinal apposition and preserve retinal function; yet the most used substitutes are gases and oils which have disadvantages including strict face-down positioning post-surgery and the need for subsequent surgical removal, respectively. We have engineered a vitreous substitute comprised of a novel hyaluronan-oxime crosslinked hydrogel. Hyaluronan, which is naturally abundant in the vitreous of the eye, is chemically modified to crosslink with poly(ethylene glycol)-tetraoxyamine via oxime chemistry to produce a vitreous substitute that has similar physical properties to the native vitreous including refractive index, density and transparency. The oxime hydrogel is cytocompatible in vitro with photoreceptors from mouse retinal explants and biocompatible in rabbit eyes as determined by histology of the inner nuclear layer and photoreceptors in the outer nuclear layer. The ocular pressure in the rabbit eyes was consistent over 56 d, demonstrating limited to no swelling. Our vitreous substitute was stable in vivo over 28 d after which it began to degrade, with approximately 50% loss by day 56. We confirmed that the implanted hydrogel did not impact retina function using electroretinography over 90 days versus eyes injected with balanced saline solution. This new oxime hydrogel provides a significant improvement over the status quo as a vitreous substitute.
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Affiliation(s)
- Alexander E G Baker
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada; Institute of Biomedical Engineering, University of Toronto, 160 College St, Toronto, ON, M5S 3E1, Canada
| | - Hong Cui
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada
| | - Brian G Ballios
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St, Toronto, ON, L0J 1C0, Canada
| | - Sonja Ing
- Institute of Biomedical Engineering, University of Toronto, 160 College St, Toronto, ON, M5S 3E1, Canada
| | - Peng Yan
- Kensington Eye Institute, 340 College St, Toronto, ON, M5T 3A9, Canada
| | - Joe Wolfer
- Toronto Animal Eye Clinic, 150 Norseman St, Etobicoke, ON, M8Z 2R4, Canada
| | - Thomas Wright
- Kensington Eye Institute, 340 College St, Toronto, ON, M5T 3A9, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St, Toronto, ON, L0J 1C0, Canada
| | - Mickael Dang
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada
| | - Nicola Y Gan
- Department of Ophthalmology, Tock Seng Hospital, National Healthcare Group Eye Institute, 11 Jln Tan Tock Seng, 308433, Singapore
| | - Michael J Cooke
- Institute of Biomedical Engineering, University of Toronto, 160 College St, Toronto, ON, M5S 3E1, Canada
| | - Arturo Ortín-Martínez
- Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Valerie A Wallace
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St, Toronto, ON, L0J 1C0, Canada; Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, ON, M5S 1A8, Canada
| | - Derek van der Kooy
- Department of Molecular Genetics, University of Toronto, 1 King's College Circle, ON, M5S 1A8, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, ON, M5S 1A8, Canada
| | - Robert Devenyi
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St, Toronto, ON, L0J 1C0, Canada; Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada; Toronto Western Hospital, 399 Bathurst St, Room 6 E W 438, Toronto, ON, M5T 2S8, Canada
| | - Molly S Shoichet
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada; Institute of Biomedical Engineering, University of Toronto, 160 College St, Toronto, ON, M5S 3E1, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, ON, M5S 1A8, Canada.
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Wenzel DA, Kunzmann BC, Druchkiv V, Hellwinkel O, Spitzer MS, Schultheiss M. Effects of Perfluorobutylpentane (F4H5) on Corneal Endothelial Cells. Curr Eye Res 2019; 44:823-831. [PMID: 30892089 DOI: 10.1080/02713683.2019.1597891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To evaluate the effects of perfluorobutylpentane (F4H5) on corneal endothelial cell density (ECD) and morphology using a porcine corneal endothelial organ culture model. Materials and methods: "Split corneal buttons" were cultivated for 15 days (d) after incubation in F4H5 (15, 30, 60, and 120 min) or BSS (controls). ECD was assessed manually on d1, d8, and d15. After histological staining (trypan blue, alizarin red S) on d15 morphological changes (reformation figures, rosette formations, and alizarin red cells) were evaluated. Results: ECD was significantly reduced after incubation in F4H5 for 120 min (median ± 25%/75%-quartile; 3281 ± 43/222 cells/mm2; p = 0.046) on d15 compared to controls (3658 ± 129/296 cells/mm2), but not after shorter incubation times (15, 30, and 60 min). Morphological assessment supports these findings as reformation figures (F4H5 120 min: 10.5 ± 9.3/13.9/mm2 vs. controls: 5.2 ± 2.8/7.2/mm2; p = 0.010), rosette formations (F4H5 120 min 25.566 ± 17.044/36.219/mm2 vs. controls: 8.333 ± 0.000/15.667/mm2; p = 0.002), and alizarin red cells (F4H5 120 min: 38.350 ± 29.827/51.333/mm2 vs. controls: 20.833 ± 10.417/25.000/mm2; p = 0.049) were significantly more prevalent after incubation in F4H5 for 120 min compared to controls. Also, F4H5 60 min showed significantly more rosette formations (25.452 ± 16.968/36.057/mm2; p = 0.006) and alizarin red cells (46.662 ± 42.420/50.903/mm2; p = 0.007), but not reformation figures (7.0 ± 2.2/1.6 %; p = 0.953). Conclusion: Short exposure (≤30 min) of porcine corneal endothelial cells to F4H5 does not have significant effects on ECD or morphological characteristics. Longer exposure times (≥60-120 min) may cause ECD decline and/or induce morphological changes.
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Affiliation(s)
- Daniel A Wenzel
- a Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg , Germany
| | - Berenike C Kunzmann
- b Center of Ophthalmology, University Eye Hospital Tübingen , Tübingen , Germany
| | - Vasyl Druchkiv
- a Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg , Germany
| | - Olaf Hellwinkel
- c Center for Diagnostics, Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg , Germany
| | - Martin S Spitzer
- a Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg , Germany
| | - Maximilian Schultheiss
- a Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg , Germany
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Li QC, Yu J, Jiang CH, Zhu HH, Liu K, Zhao JC. Effects of perfluorooctane on the retina as a short-term and small amounts remnant in rabbits. Int J Ophthalmol 2019; 12:381-386. [PMID: 30918804 DOI: 10.18240/ijo.2019.03.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/25/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate changes in the rabbit retina after short-term and small amounts tamponade of perfluorooctane (PFO). METHODS New Zealand rabbits were used, and 48 eyes were randomly and evenly assigned into four different groups. The PFO groups received a residue of 0.1 mL of PFO for ophthalmic surgery or 0.1 mL of F-Octane at the end of surgery; eyes from the pars plana vitrectomy (PPV) group were filled with balanced salt solution and those having not received surgical intervention served as controls. Eyes were collected at 1, 4 and 12wk and studied. RESULTS Under a microscope, nuclear counts of the inner nuclear layer (INL) and outer nuclear layer (ONL) did not differ among the four groups at all time points; however, slight disarrangement of the ONL and occasional vacuolization of the INL were found in the inferior retina only at 12wk in two PFO groups. Four of the groups had similar results of Caspase-3 and TNF-α staining at all time points. Alternatively, IL-8 was increased in PFOa and PPV control groups at 4wk and in all three PPV groups at 12wk; also, the apoptotic index (%) was similarly increased in all three PPV groups at 4 and 12wk. CONCLUSION Both PFOs are well tolerated in rabbit eyes for up to 12wk, which suggests that they can be used safely as intraoperative tools or for short-term and small amounts tamponade after surgery.
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Affiliation(s)
- Qing-Chen Li
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China.,Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China.,Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Chun-Hui Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China.,Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China.,Department of Ophthalmology, People's Hospital of Shanghai No. 5, Shanghai 200240, China
| | - Hao-Hao Zhu
- Department of Ophthalmology, People's Hospital of Shanghai No. 5, Shanghai 200240, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai 200080, China
| | - Jin-Chuan Zhao
- ZHEJIANG Institute of Medical Device Supervision and Testing, Hangzhou 310018, China
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Coco RM, Srivastava GK, Andrés-Iglesias C, Medina J, Rull F, Fernandez-Vega-Gonzalez A, Fernandez-Bueno I, Dueñas A, Pastor JC. Acute retinal toxicity associated with a mixture of perfluorooctane and perfluorohexyloctane: failure of another indirect cytotoxicity analysis. Br J Ophthalmol 2018; 103:49-54. [DOI: 10.1136/bjophthalmol-2017-311471] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/21/2018] [Accepted: 02/28/2018] [Indexed: 11/04/2022]
Abstract
AimsTo report new information related to acute retinal toxicity of Bio Octane Plus, a mixture of 90% perfluorooctane (PFO) and 10% perfluorohexyloctane.MethodsThis retrospective, descriptive case series reports the occurrence of acute retinal toxicity after vitreoretinal surgery in which Bio Octane Plus (batch number 1605148) was used as an endotamponade. Cytotoxicity biocompatibility tests and chemical analyses by Fourier-transformed infrared (FTIR) spectroscopy and gas chromatography-mass spectrometry (GC-MS) of the presumed toxic product were performed.ResultsFour patients presented with acute severe visual loss after uneventful ocular surgery assisted by Bio Octane Plus (batch number 1605148) as endotamponade. Patients experienced extensive retinal vascular occlusion leading to retinal and optic nerve atrophy. The viability of ARPE-19 cells directly exposed to the suspect batch for 30 min was 0%. The agarose overlay method used by the manufacturer according to European Union regulations and International Organization for Standardization (ISO) International Standards failed to detect toxicity. FTIR spectroscopy showed small differences between the non-toxic and toxic batches. GC-MS analysis showed the presence of bromotributyl stannane (whose toxicity was demonstrated in the dose–response curve) only in the toxic batch of Bio Octane Plus.ConclusionThis is the third report of retinotoxicity due to PFO in 4 years. The clinical profiles may be missed as they resemble other postsurgical complications; therefore, more cases worldwide could have gone unreported. Protocols to determine cytotoxicity of intraocular medical devices and approved by the ISO International Standards based on indirect methods have failed and should be revised to ensure safety.
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Mustapha M, Roufail Franzco E. Bilateral Giant Retinal Tear and Sequential Vitrectomy. Case Rep Ophthalmol 2017; 8:436-439. [PMID: 28924443 PMCID: PMC5597925 DOI: 10.1159/000479728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/18/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the excellent outcome of surgery for bilateral giant retinal tears (GRTs) with better options of endotamponade. Methods This is a case report of a 62-year-old man who presented with bilateral GRTs and associated retinal detachment. The tear in the right eye was supero-temporal and silicone oil was used as an endotamponade. The tear in the left eye was infero-temporal and perfluorocarbon liquid was used as an endotamponade. Results The outcome at 6 months after surgery was excellent with visual acuities of 6/6 in both eyes. Conclusion Improved availability of endotamponade agents allows repair of bilateral GRTs to be done at the same time, with good surgical outcomes.
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Affiliation(s)
- Mushawiahti Mustapha
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Shulman M, Sepah YJ, Chang S, Abrams GW, Do DV, Nguyen QD. Management of Retained Subretinal Perfluorocarbon Liquid. Ophthalmic Surg Lasers Imaging Retina 2013; 44:577-83. [DOI: 10.3928/23258160-20131105-07] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/22/2013] [Indexed: 11/20/2022]
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Wong IY, Wong D. Special Adjuncts to Treatment. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Georgalas I, Ladas I, Tservakis I, Taliantzis S, Gotzaridis E, Papaconstantinou D, Koutsandrea C. Perfluorocarbon liquids in vitreoretinal surgery: a review of applications and toxicity. Cutan Ocul Toxicol 2011; 30:251-62. [DOI: 10.3109/15569527.2011.560915] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chiquet C, Thuret G. [Perfluorocarbon liquids and vitreoretinal surgery in 2011]. J Fr Ophtalmol 2011; 34:663-77. [PMID: 21943797 DOI: 10.1016/j.jfo.2011.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 11/29/2022]
Abstract
Perfluorocarbon liquids (PFCLs) are one of the most innovative recent tools for vitreoretinal surgery. PFCLs are characterized by their number of carbon atoms, which has an impact on the density, viscosity, surface tension, vapor pressure, the boiling point, and the refraction index. PFCLs are routinely used because of their high gravity (double that of water) and their low viscosity. Furthermore, they are immiscible in water, optically clear with refraction indices similar to that of water, allowing visualization of an interface between the PFCL and saline. The use of intravitreally injected liquid PFCLs as adjunctive agents to vitreoretinal surgery plays an important role in facilitating retinal reattachment, especially in cases of giant retinal tear, trauma, and/or proliferative vitreoretinopathy. PFCLs are also used as intraoperative instruments to re-establish intraocular volume, assist in separating membranes adherent to the retina (in proliferative diabetic retinopathy, for example), and manage the dislocated crystalline lens and intraocular lens.
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Affiliation(s)
- C Chiquet
- Clinique universitaire d'ophtalmologie, université Joseph-Fourier-Grenoble-1, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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Krafft MP, Riess JG. Chemistry, physical chemistry, and uses of molecular fluorocarbon--hydrocarbon diblocks, triblocks, and related compounds--unique "apolar" components for self-assembled colloid and interface engineering. Chem Rev 2009; 109:1714-92. [PMID: 19296687 DOI: 10.1021/cr800260k] [Citation(s) in RCA: 334] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Marie Pierre Krafft
- Université de Strasbourg, Institut Charles Sadron (SOFFT-CNRS), 23 rue du Loess, 67034 Cedex, Strasbourg, France.
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The concept of heavy tamponades—chances and limitations. Graefes Arch Clin Exp Ophthalmol 2008; 246:1217-24. [DOI: 10.1007/s00417-008-0861-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 04/28/2008] [Accepted: 04/30/2008] [Indexed: 11/30/2022] Open
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Heimann H, Stappler T, Wong D. Heavy tamponade 1: a review of indications, use, and complications. Eye (Lond) 2008; 22:1342-59. [PMID: 18344952 DOI: 10.1038/eye.2008.61] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Heavier than water intraocular tamponades have several theoretical advantages over conventional tamponades, especially in the treatment of complicated retinal detachments and proliferative viteroretinopathy of the lower fundus periphery. However, initial clinical series of various heavy tamponades have reported significant complication rates. Therefore, heavy tamponades have not found widespread acceptance. Three recently developed heavy silicone oil tamponades, Oxane HD, Densiron 68, and HWS 46-3000, are much better tolerated and presently seem to enter routine clinical practice. MATERIALS AND METHODS Literature review of 21 publications on the clinical application of 9 different heavy tamponades (fluorosilicone, C10F18, F6H8, OL62HV, Oxane HD, O62, F6H8-silicone oil mixture, Densiron 68, and HWS 46-3000). RESULTS The first generation (fluorinated silicone and perfluorocarbon liquids) and second generation (partially fluorinated alkanes) of heavy tamponades were associated with relatively high complication rates, for example, tamponade emulsification, intraocular inflammation, and rise in intraocular pressure. The complication spectrum of the new generation of heavy silicone oils (Oxane HD, Densiron 68, and HWS 46-3000) seems to be comparable to conventional silicone oil tamponades while providing better support for the inferior retina and the posterior pole. CONCLUSION The recently developed heavy silicone oil tamponades are safe and effective tools for the use of complicated retinal detachments of the inferior fundus.
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Affiliation(s)
- H Heimann
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
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Heavy tamponade 2 Densiron 68 in routine clinical practice: anatomical and functional outcomes of a consecutive case series. Eye (Lond) 2008; 22:1360-5. [PMID: 18309331 DOI: 10.1038/eye.2008.62] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of Densiron 68 in the clinical management of complex vitreoretinal cases with inferior retinal pathology. METHODS We present a prospective interventional non-comparative case series of 122 eyes of 121 consecutive patients. The primary end point was anatomical re-attachment of the retina, defined as retinal re-attachment in the absence of any tamponade agent. The secondary end point was to record the visual function and surgical complications. Inclusion criteria were proliferative vitreoretinopathy, posterior or inferior retinal breaks, and the patient's inability to posture. RESULTS Patients were 59.9 years (+/- 19.6), (m/f= 72:49), (R/L=65:57). Seventy-seven (63.1%) had previous unsuccessful retinal surgery and 45 had Densiron 68 at first procedure. The extent of the detachments was 2.21 quadrants (+/- 1.07) with macular involvement in 66 cases (54%). Eighty-seven (71.3%) patients achieved retinal re-attachment with one retinal operation and ultimately no tamponade, 102 (83.6%) achieved retinal re-attachment with more than one operation and ultimately no tamponade, and 112 (91.3%) patients achieved flat retina with tamponade in situ. Visual acuity rose from 1.38 LogMar (+/- 0.87) to 1.06 (+/- 0.83) (P=0.007). Densiron was removed after 135 days (+/- 73.2; range 35-405). CONCLUSION No tamponade agent can provide simultaneous support for the superior as well as the inferior retina; therefore, a tamponade agent that 'sinks' is a welcome new tool at the surgeon's disposal. The sequential use of heavy silicone oil followed by conventional silicone oil may be an acceptable management strategy in recurrent detachment.
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Sandner D, Herbrig E, Engelmann K. High-density silicone oil (Densiron) as a primary intraocular tamponade: 12-month follow up. Graefes Arch Clin Exp Ophthalmol 2008; 245:1097-105. [PMID: 17219121 DOI: 10.1007/s00417-006-0496-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Revised: 10/08/2006] [Accepted: 11/07/2006] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The high-density silicone oil (Densiron 68), a mixture of F6H8 with silicone oil, seems to be a therapeutic option, at least in selected patients with complex inferior retinal re-detachment, where standard procedures have already failed. In an interventional case series we used Densiron as a primary endotamponade. METHODS Twelve eyes of 12 patients aged 31 years to 85 years with inferior complex rhegmatogenous retinal detachment with secondary proliferative vitreoretinopathy (PVR) grades CP2 to CA8 were included. Surgical techniques (pars plana vitrectomy, membrane peeling, retinotomy, retinectomy, endophotocoagulation, cryocoagulation, endotamponade) did not include a scleral buckling procedure (except one eye). Mean duration of the Densiron endotamponade was 78.3 +/- 29.74 days, with a mean follow up after removal of 400.6 +/- 85.4 days. RESULTS After Densiron removal, four patients (33.3%) showed a stable reattached retina without further interventions, while, in six patients (50%), recurrent retinal re-detachment appeared during endotamponade, generally within 2 months. One patient (8.3%) developed re-detachment 5 months after Densiron removal. One eye (8.3%) lost light perception due to severe intraretinal fibrosis with chronic hypotonia, despite complete retinal re-attachment. Visual acuity improved from mean logarithm of the minimum angle of resolution (logMAR) of 2.95 +/- 1.21 to 1.87 +/- 1.32 (statistically significant, P = 0.022). Side effects included temporary inflammatory reaction/fibrin accumulation (n = 2/2), moderate-to-severe intraretinal fibrosis (n = 3), elevated intraocular pressure (IOP) (n = 3), emulsification (n = 2), sterile hypopyon (n = 1), vitreous haemorrhage (n = 1) and chronic hypotony (n = 1). CONCLUSION Primary anatomical success rate of 33.3% was less encouraging than as expected. Especially, re-detachments within the posterior staphyloma in highly myopic patients were common during Densiron endotamponade. However, the surgical success increased to 75% after reintervention, even without the use of an additional encircling band. The observed adverse effects and the functional outcomes do not contraindicate the use of Densiron as an internal tamponade for a period of 3 months.
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Affiliation(s)
- Dirk Sandner
- Department of Ophthalmology, Medical Faculty "Carl Gustav Carus", Dresden University of Technology, Fetscherstrasse 74, 01307 Dresden, Germany.
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Matteucci A, Formisano G, Paradisi S, Carnovale-Scalzo G, Scorcia G, Caiazza S, Hoerauf H, Malchiodi-Albedi F. Biocompatibility assessment of liquid artificial vitreous replacements: relevance of in vitro studies. Surv Ophthalmol 2007; 52:289-99. [PMID: 17472804 DOI: 10.1016/j.survophthal.2007.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The biocompatibility of liquid artificial vitreous replacements is generally assessed by performing tests in animal models before their clinical use, whereas in vitro experimentation is seldom carried out due to their physico-chemical characteristics. Since their introduction in vitreoretinal surgery, however, the use of some certified vitreous replacements has been discouraged after clinical trials, because of the occurrence of serious side effects. This observation suggests that the tests currently performed for biocompatibility assessment cannot fully guarantee their safety when they are used in humans. Here we review the available literature on in vitro biocompatibility testing of liquid artificial vitreous replacements and survey our own experience on the subject, obtained by using primary retinal cell cultures, seeded on micro-porous inserts. We suggest that in vitro biocompatibility assessment, conducted before experiments in animal models, could improve the required safety evaluation and decrease the risk of undesired side effects, as well as providing a beneficial reduction of animal experimentation.
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Affiliation(s)
- Andrea Matteucci
- G.B. Bietti Foundation for Ophthalmology (I.R.C.C.S.), Rome, Italy
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Mackiewicz J, Maaijwee K, Lüke C, Kociok N, Hiebl W, Meinert H, Joussen AM. Effect of gravity in long-term vitreous tamponade: in vivo investigation using perfluorocarbon liquids and semi-fluorinated alkanes. Graefes Arch Clin Exp Ophthalmol 2006; 245:665-75. [PMID: 17033791 DOI: 10.1007/s00417-006-0414-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2006] [Revised: 06/22/2006] [Accepted: 07/04/2006] [Indexed: 11/28/2022] Open
Abstract
PURPOSE In order to investigate whether gravity is the reason for retinal degeneration in long-term vitreous tamponade, perfluorohexyloctane (F6H8), perfluorodecalin (PFD), and a mixture of F6H8/PFD were compared. MATERIALS AND METHODS Each group of 5 rabbits received a 3-month tamponade with either PFD (pure) (1.93 g/cm(3)), F6H8 (pure) (1.33 g/cm(3)), or a 1:1 mixture of F6H8/PFD (1.62 g/cm(3)). Electroretinograms (ERG) were performed pre- and postoperatively. Lower and upper retinal areas were compared using immunohistochemical methods. Transmission electron microscopy was performed to investigate alterations in the photoreceptors. RESULTS All three substances were tolerated well in rabbit eyes for up to 3 months. Dispersion was seen earliest with PFD and latest with pure F6H8. None of the substances demonstrated inflammatory reactions or vascular alterations. ERGs were not considerably altered with any of the substances. Histology of the retina showed alterations in the cell counts within the inner and outer nuclear layer that were not attributable to the gravity of the tamponading agent. CONCLUSION In contrast to previously published work, this study did not detect any tamponade-related structural damage of the retina after a 3-months tamponade in the rabbit model. Based upon this study, we conclude that gravity might not be causally linked to retinal damage.
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Affiliation(s)
- Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
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Sandner D, Engelmann K. First experiences with high-density silicone oil (Densiron) as an intraocular tamponade in complex retinal detachment. Graefes Arch Clin Exp Ophthalmol 2005; 244:609-19. [PMID: 16205937 DOI: 10.1007/s00417-005-0110-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 07/28/2005] [Accepted: 08/03/2005] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In this study, we evaluated the anatomic and functional outcome and intraocular adverse effects after a 3-month endotamponade with Densiron 68, a mixture of F(6)H(8) with silicone oil, in complex inferior re-detachments. METHODS Forty-eight eyes of 48 patients aged 27-82 years with retinal re-detachment due to proliferative vitreoretinopathy (PVR) grades CP1 to CA7 were included. Mean duration of the Densiron endotamponade was 108.7+/-66.9 days, with a mean follow-up after removal of 102.8+/-31.9 days. RESULTS Twenty-two patients (45.8%) showed stable retinal reattachment after Densiron removal. Fourteen patients (29.2%) developed retinal re-detachment after removal, generally within 1 month and in the upper circumference (n=8). In 11 patients (22.9%) recurrent re-detachment (inferior n=8) appeared during Densiron endotamponade. In one eye (2.1%) treatment was primarily unsuccessful. Visual acuity improved from mean logMAR 1.66+/-1.03 to 1.47+/-0.97 (not statistically significant, P=0.257). Side effects included temporary inflammatory reaction (n=10), fibrin accumulation (n=6), sterile hypopyon (n=2), vitreous hemorrhage (n=6), elevated IOP (n=5), emulsification (n=4) and chronic hypotony (n=4). CONCLUSION The anatomical success rate without further interventions of 45.8% (22 of 48 patients) seems unsatisfactory. However, in evaluating the potential of Densiron, it should be considered that all patients in this study had previous surgery with standard procedures, including silicone oil, which had already failed. Intraoperative laser photocoagulation of the periphery of the upper quadrants might reduce the risk of retinal re-detachments.
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Affiliation(s)
- Dirk Sandner
- Department of Ophthalmology, Medical Faculty Carl Gustav Carus, University of Technology Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
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