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Shukla D, Kalliath J, Dhawan A. Reply. Retina 2024; 44:e45-e46. [PMID: 38484094 DOI: 10.1097/iae.0000000000004098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
| | | | - Anuradha Dhawan
- Clinical Research Associate, Vitreous Retina Macula Specialists of Toronto, Toronto, Canada
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Loiudice P, Pintor ES, Tronci C, Tatti F, Casini G, Figus M, Demarinis G, Peiretti E. Safety and efficacy of cryopexy during pars Plana vitrectomy in rhegmatogenous retinal detachment. Eur J Ophthalmol 2023; 33:2285-2289. [PMID: 36987589 DOI: 10.1177/11206721231166976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE To evaluate efficacy and safety of intraoperative cryoretinopexy in cases of rhegmatogenous retinal detachment (RRD). METHODS In this retrospective, interventional case series, we review the medical records of 85 consecutive cases of RRD treated with pars plana vitrectomy and gas tamponade, without the use of perfluorocarbon liquids. Baseline best-corrected visual acuity, intraocular pressure, number and location of retinal breaks, location and extension of retinal detachment, duration of symptoms, macula status, presence, and grade of proliferative vitreoretinopathy (PVR) were registered. Follow-up visits were at 1 day, 15 days, 1 month and 3 months. Anatomical and functional outcomes and any adverse event were recorded. RESULTS Primary anatomical success was obtained in 82/85 patients (96%). During the postoperative period, PVR was observed in 4/85 cases (4.7%), 3 of whom developed recurrence of retinal detachment. 7/85 (8.2%) patients developed ocular hypertension. We built a model of logistic regression including age, sex, lens status, macula status, number of quadrants involved, number of ruptures and duration of symptoms. None of the variables considered was found to be a predictor of postoperative PVR development. Symptom's duration (β = 0.429; 95% CI = 0.009-0.023; P < 0.001) and preoperative BCVA (β = 0.273; 95% CI = 0.034-0.184; P = 0.005) were predictors for final BCVA. CONCLUSION These findings emphasize the safety and efficacy of the use of intraoperative cryotherapy, associated with PPV and gas tamponade, for the management of uncomplicated RRDs.
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Affiliation(s)
- Pasquale Loiudice
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Claudia Tronci
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Giamberto Casini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Demarinis
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
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Shukla D, Dhawan A, Kalliath J. MEDIUM-TERM PERFLUORO-N-OCTANE AS RESCUE POSTOPERATIVE TAMPONADE FOR VERY COMPLEX RETINAL DETACHMENTS: ANATOMICAL AND FUNCTIONAL OUTCOMES. Retina 2023; 43:905-912. [PMID: 36791344 DOI: 10.1097/iae.0000000000003763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE To report the anatomical and functional outcomes of medium-term perfluoro-n-octane (PFO) tamponade as a rescue procedure in very complex retinal detachments (RDs). METHODS We reviewed the case records of 35 consecutive patients who underwent vitrectomy for very complex RDs due to diverse etiologies. The surgical complexity was so graded because of the intraoperative failure to ascertain complete retinal reattachment; perfluoro-n-octane was used as rescue tamponade for 2 to 4 weeks. The second intervention included additional membrane peeling, retinectomy, endophotocoagulation, and gas/silicone oil tamponade. The minimum follow-up was 3 months after the final intervention: the primary outcome was retinal reattachment and the secondary outcome was change in best-corrected visual acuity (BCVA). RESULTS The most common presentations were severe trauma with retinal incarceration, preretinal and subretinal hemorrhage, or chronic/recurrent RDs with anterior proliferative vitreoretinopathy. Preoperative BCVA was ≤counting fingers in 31 (88.6%) patients. Complete retinal attachment without any tamponade was achieved in 33 (94.3%) eyes. best-corrected visual acuity improved in 30 (85.7%) eyes: 16 (45.7%) had BCVA ≥20/200 and 21 (60%) regained ambulatory vision (≥5/200). Two eyes developed keratopathy, and four needed antiglaucoma medications. CONCLUSION We achieved excellent anatomical outcomes and acceptable functional outcomes in nearly inoperable RDs with few side effects. Medium-term perfluoro-n-octane tamponade can be used as a salvage procedure in very complex RDs where intraoperative reattachment cannot be ensured.
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Affiliation(s)
| | - Anuradha Dhawan
- Calderdale Huddersfield Foundation NHS Trust Hospital, UK; and
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Trabelsi O, Bouladi M, Ouertani A, Trabelsi A. Short-Term Total Tamponade with Perfluorocarbon Liquid and Silicone Oil in Complex Rhegmatogenous Retinal Detachment with Severe Proliferative Vitreoretinopathy. Clin Ophthalmol 2023; 17:515-525. [PMID: 36789290 PMCID: PMC9922565 DOI: 10.2147/opth.s400156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Background To evaluate retinal reattachment, visual functional results, and complications rates after total tamponade (TT) with perfluorocarbon liquid (PFCL) and silicone oil (SO) for 2 days followed by PFCL-SO exchange in complex retinal detachment (RD). Methods Retrospective study including 52 consecutive eyes with complex RD and advanced proliferative vitreoretinopathy, who underwent vitrectomy with TT. Patients underwent first surgery by 25-Gauge vitrectomy and partial PFCL-SO exchange (approximately 60% PFCL 40% SO fill) followed by second surgery with extraction of the PFCL and complete SO fill. Results After a mean follow-up period of 25.15 ± 6.6 months, the retina remained reattached in 48/52 eyes (92.3%) including 28 eyes (58.3%) without SO and 20 eyes (41.7%) with prolonged SO tamponade. Visual acuity improved in 45 eyes (86.6%) (P<0.001), remained stable in 4 eyes (7.7%) and decreased in 3 eyes (5.7%). Complications consisted in mild anterior chamber inflammation in 10 eyes, ocular hypertension in 12 eyes, and cataract in 10 eyes. Conclusion Two-day TT with PFCL and SO may be considered in complex RD with advanced proliferative vitreoretinopathy especially in monocular patients. Further studies with longer follow-up period and retinal electrophysiologic assessment may be needed.
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Affiliation(s)
| | - Mejda Bouladi
- Department of Surgery, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,Correspondence: Mejda Bouladi, Faculty of Medicine of Tunis, University of Tunis El Manar, 24, rue Amilcar, cité Wifec, 2070, La Marsa, Tunis, Tunisia, Tel +21698561086, Email
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Thackaberry EA, Lorget F, Farman C, Bantseev V. The safety evaluation of long-acting ocular delivery systems. Drug Discov Today 2019; 24:1539-1550. [DOI: 10.1016/j.drudis.2019.05.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/09/2019] [Accepted: 05/31/2019] [Indexed: 01/14/2023]
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Barth H, Crafoord S, Arnér K, Ghosh F. Inflammatory responses after vitrectomy with vitreous substitutes in a rabbit model. Graefes Arch Clin Exp Ophthalmol 2019; 257:769-783. [DOI: 10.1007/s00417-019-04242-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/27/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022] Open
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Ling KP, Wu AL, Lai CC, Wu WC. Short-term postoperative perfluoro-n-octane tamponade for pediatric recurrent retinal detachment. Taiwan J Ophthalmol 2019; 8:249-252. [PMID: 30637197 PMCID: PMC6302560 DOI: 10.4103/tjo.tjo_100_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case with multiple recurrences of retinal detachment (RD) with severe proliferative vitreoretinopathy in a 12-year-old child who underwent vitrectomy using a heavy liquid perfluoro-n-octane (PFO) as a short-term postoperative tamponade. He had an encircling band and three vitrectomies with gas, followed by silicone oil tamponade for retinal redetachment prior to the use of PFO as a short-term tamponade. Short-term PFO tamponade was used in which inferior retinal reattachment was considered to be difficult with conventional gas or silicone oil tamponade, especially in regard to proper postoperative posturing. The PFO was left in the eye for 1 week, and the retina remained reattached after removal of the PFO which was replaced with silicone oil tamponade in this case. PFO appears feasible and tolerable as a short-term postoperative tamponade in the management of complex pediatric RD.
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Affiliation(s)
- Kiet-Phang Ling
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Ophthalmology, Sultanah Aminah Hospital, Johor, Malaysia
| | - An-Lun Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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MANAGEMENT OF GIANT RETINAL TEARS USING TRANSSCLERAL DIODE LASER RETINOPEXY AND SHORT-TERM POSTOPERATIVE TAMPONADE WITH PERFLUORO-N-OCTANE. Retina 2018; 40:546-551. [PMID: 30576303 DOI: 10.1097/iae.0000000000002424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the results of pars plana vitrectomy for giant retinal tear detachments using transscleral diode laser retinopexy and short-term postoperative tamponade with perfluoro-n-octane (PFnO). METHODS Twenty consecutive patients with fresh giant retinal tears were enrolled in a single-arm prospective study. One case was withdrawn for technical reasons. The remainder all underwent pars plana vitrectomy, PFnO injection, transscleral diode laser retinopexy to the edge of the giant retinal tear, and short-term postoperative heavy liquid tamponade. None of the cases had scleral buckling or lensectomy. RESULTS Nineteen cases (18 male and 1 female) with a mean age of 41 years (range 10-69 years) were followed up for a period of 6 months. Postoperative tamponade with PFnO was maintained for a mean of 7.6 days (range 4-21 days), after which it was exchanged for sulfur hexafluoride (SF6), perfluoropropane (C3F8) gas, or balanced salt solution. Final reattachment rate was 100%, with 3 (15.7%) patients requiring additional surgery. Best-corrected visual acuity at final follow-up was 20/40 or better in 11 eyes (58%), between 20/60 and 20/200 in 7 (37%), and 20/400 in 1 (5%). CONCLUSION In this series of acute giant retinal tears, transscleral diode laser retinopexy together with the use of PFnO for short-term postoperative tamponade achieved excellent anatomical and visual results.
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Surgical outcomes of 27-gauge pars plana vitrectomy with short-term postoperative tamponade of perfluorocarbon liquid for repair of giant retinal tears. Int Ophthalmol 2017. [PMID: 28643005 DOI: 10.1007/s10792-017-0613-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the use of 27-gauge pars plana vitrectomy (PPV) with short-term tamponade of perfluorocarbon liquid (PFCL) for repair of giant retinal tears (GRT). METHODS Retrospective case series study. Consecutive patients with GRT were treated with 27-gauge PPV and short-term tamponade of PFCL for 7-10 days. PFCL was completely removed with a secondary surgery. RESULTS Twenty-three eyes of 23 patients were included. All the patients achieved primary anatomic success. Preoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 1.59 ± 0.58 (Snellen 20/778). Five (21.7%), nine (39.1%), eleven (47.8%) and fifteen (65.2%) eyes experienced vision improvement at the Month-1, Month-3, Month-6 and final follow-ups, respectively. The final logMAR BCVA was 0.84 ± 0.51 (Snellen 20/138), being statistically better than the preoperative one (P < 0.001). Surgical complications included foreign body response (n = 7), transient elevated intraocular pressure (n = 5), cataract formation/deterioration (n = 11) and posterior capsule opacity (n = 16). CONCLUSIONS 27-Gauge PPV with short-term tamponade of PFCL is safe and effective for the repair of GRT. Side effects of the surgery mainly included foreign body response, transient elevated intraocular pressure, cataract formation/deterioration and posterior capsule opacity.
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Fleissig E, Barak A, Goldstein M, Loewenstein A, Schwartz S. Massive subretinal and subretinal pigment epithelial hemorrhage displacement with perfluorocarbon liquid using a two-step vitrectomy technique. Graefes Arch Clin Exp Ophthalmol 2017; 255:1341-1347. [DOI: 10.1007/s00417-017-3648-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/12/2017] [Accepted: 03/20/2017] [Indexed: 11/29/2022] Open
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Alharbi SS, Asiri MS. Reversible Corneal Toxicity of Retained Intracameral Perfluoro-n-octane. Middle East Afr J Ophthalmol 2017; 23:277-9. [PMID: 27555718 PMCID: PMC4968155 DOI: 10.4103/0974-9233.186160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 58-year-old female presented with intracameral retained perfluoro-n-octane (PFO) following previous retinal reattachment surgery. After 4 years of follow-up without related sequelae, the patient complained of a gradual decrease in vision secondary to corneal edema with whitish corneal precipitate inferiorly corresponding to the area of retained PFO. Three weeks after anterior chamber washout, corneal edema resolved and the patient obtained 20/40 visual acuity. Even though PFO considered to have a relatively good safety profile, early anterior chamber washout may prevent corneal toxicity and avoid later persistent corneal decompensation.
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Affiliation(s)
- Saad S Alharbi
- Department of Ophthalmology, Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohammed S Asiri
- Department of Retina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Eiger-Moscovich M, Gershoni A, Axer-Siegel R, Weinberger D, Ehrlich R. Short-Term Vitreoretinal Tamponade with Heavy Liquid Following Surgery for Giant Retinal Tear. Curr Eye Res 2017; 42:1074-1078. [PMID: 28157410 DOI: 10.1080/02713683.2016.1266664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To study the efficacy and outcomes of short-term postoperative vitreoretinal tamponade with perfluorocarbon heavy liquid in patients with giant retinal tear. MATERIALS AND METHODS The study group consisted of 13 consecutive patients (13 eyes) who presented with giant retinal tear at a tertiary medical center in 2011-2015 and were treated with vitrectomy followed by short-term tamponade with perfluorocarbon heavy liquid. A minimum of 3 months' follow-up was required for inclusion. The medical charts were retrospectively reviewed for patient demographics, procedural specifics, anatomical attachment rates, pre- and postoperative visual acuity, and postoperative complications. RESULTS The duration of perfluorocarbon tamponade ranged from 6 to 13 days (mean ± SD 10 ± 2 days). Follow-up time ranged from 3 to 44 months (mean ± SD 11 ± 11 months). Retinal reattachment was achieved intraoperatively in all patients. Repeated detachment with proliferative vitreoretinopathy occurred in one patient (8%), who underwent repeated vitrectomies. At the last follow-up visit, the retina was attached in all patients. Best-corrected visual acuity improved postoperatively compared with preoperatively in all three patients with macula-off retinal detachment (100%) and was equal to or better than the initial best-corrected visual acuity in 6 (60%) of the 10 patients with macula-on retinal detachment. Complications included increased intraocular pressure, cataract, and cystoid macular edema. CONCLUSIONS Perfluorocarbon heavy liquid is a safe and effective material for short-term vitreoretinal tamponade following vitrectomy for giant retinal tear.
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Affiliation(s)
- Maya Eiger-Moscovich
- a Department of Ophthalmology , Rabin Medical Center - Beilinson Hospital , Petach Tikva , Israel
| | - Assaf Gershoni
- a Department of Ophthalmology , Rabin Medical Center - Beilinson Hospital , Petach Tikva , Israel
| | - Ruth Axer-Siegel
- a Department of Ophthalmology , Rabin Medical Center - Beilinson Hospital , Petach Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Dov Weinberger
- a Department of Ophthalmology , Rabin Medical Center - Beilinson Hospital , Petach Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Rita Ehrlich
- a Department of Ophthalmology , Rabin Medical Center - Beilinson Hospital , Petach Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Oellers P, Schneider EW, Fekrat S, Mahmoud TH, Mruthyunjaya P, Hahn P. Retained Intraocular Perfluoro-n-octane After Valved Cannula Pars Plana Vitrectomy for Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina 2015; 46:451-6. [PMID: 25970866 DOI: 10.3928/23258160-20150422-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 12/04/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate cases of retained intraocular perfluoro-n-octane (PFO) after pars plana vitrectomy (PPV) for retinal detachment (RD). PATIENTS AND METHODS Retrospective, noncomparative case series of six eyes with retained intraocular PFO after RD repair. Clinical data were supplemented with an experimental silicone eye model. RESULTS A cluster of six cases of retained intraocular PFO after PPV for RD repair were noted shortly after transitioning to valved cannulas. PFO was noted in the anterior chamber (AC) and/or vitreous and removed with AC paracentesis, AC wash-out, and/or PPV. A silicone eye model demonstrated that PFO levels are maintained anterior to cannula insertion with valved cannulas only. CONCLUSION The authors hypothesize that anterior PFO fill using valved cannulas can lead to sequestration within the AC, zonules, ciliary sulcus, ciliary teeth, and/or capsular bag. They suggest vigilance in not overfilling PFO, particularly when transitioning to use of valved cannulas, to minimize the risk of intraocular retention.
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25-gauge pars plana vitrectomy with medium-term postoperative perfluoro-n-octane for the repair of giant retinal tears. Graefes Arch Clin Exp Ophthalmol 2015; 254:253-7. [DOI: 10.1007/s00417-015-3049-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/28/2015] [Accepted: 05/01/2015] [Indexed: 11/28/2022] Open
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Inflammation induced by perfluorocarbon liquid: intra- and postoperative use. BIOMED RESEARCH INTERNATIONAL 2014; 2014:907816. [PMID: 24783224 PMCID: PMC3982253 DOI: 10.1155/2014/907816] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/24/2014] [Indexed: 11/17/2022]
Abstract
Perfluorocarbon liquids (PFCLs) are useful and safe surgical tools in vitreoretinal surgery. The use of PFCL as a tamponade has been controversial due to the corneal toxicity, retinal infiltration, and inflammatory reaction in experimental studies. Several authors have studied in humans the anatomical and functional outcome and adverse effects of perfluorocarbon liquids used as short-, medium-, and long-term tamponade. PFCLs develop dispersion a few days after injection and droplets may move into the anterior chamber and cause corneal endothelial damage. When PFCLs are used as postoperative tamponades for more than one week, a foreign-body inflammatory reaction is observed in up to 30% of cases but such a reaction does not induce PVR, and it resolves after removal of PFCLs. Although most clinical studies have found no signs of retinal toxicity such as progressive visual acuity deterioration or macular anatomical changes, few performed ERG or retinal histological analysis.
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