Inflammation induced by perfluorocarbon liquid: intra- and postoperative use

Iatrogenic macular hole following PFCL injection: Implications of retinal dimpling as an intraoperative indicator

Background

Perfluorocarbon liquid (PFCL) revolutionized retinal detachment (RD) management in vitreoretinal surgery but introduced unique risks. Complications like subretinal migration are documented, yet specific warnings for macular hole (MH) formation during PFCL injection are lacking.

Case presentation

In a rhegmatogenous RD case, a localized retinal dimpling during PFCL jet stream injection, preceded subsequent complications-an immediate MH and subretinal PFCL migration. Subsequently, an internal limiting membrane peeling with PFCL mobilization was performed.successfully managed the situation. Post-surgery, optical coherence tomography (OCT) confirmed a closed MH with improved vision.

Conclusion

This case report not only sheds light on a previously undocumented complication associated with PFCL injection but also underscores the critical need for adherence to proper injection technique to minimize traumatic effects. Understanding the mechanism underlying this complication and implementing corrective measures are essential for enhancing intraoperative strategies and minimizing adverse outcomes in retinal surgeries involving PFCL.

Recent Developments in Slippery Liquid-Infused Porous Surface Coatings for Biomedical Applications

Slippery liquid-infused porous surface (SLIPS), inspired by the Nepenthes pitcher plant, exhibits excellent performances as it has a smooth surface and extremely low contact angle hysteresis. Biomimetic SLIPS attracts considerable attention from the researchers for different applications in self-cleaning, anti-icing, anticorrosion, antibacteria, antithrombotic, and other fields. Hence, SLIPS has shown promise for applications across both the biomedical and industrial fields. However, the manufacturing of SLIPS with strong bonding ability to different substrates and powerful liquid locking performance remains highly challenging. In this review, a comprehensive overview of research on SLIPS for medical applications is conducted, and the design parameters and common fabrication methods of such surfaces are summarized. The discussion extends to the mechanisms of interaction between microbes, cells, proteins, and the liquid layer, highlighting the typical antifouling applications of SLIPS. Furthermore, it identifies the potential of utilizing the controllable factors provided by SLIPS to develop innovative materials and devices aimed at enhancing human health.

Iatrogenic macular hole during liquid perfluorocarbon injection in retinal detachment surgery

To describe a macular hole development during intravitreal injection of perfluorocarbon liquid used to repair a regmatogenous retinal detachment. CLINICAL CASE: A 73-year-old man presented with superotemporal regmatogenous retinal detachment. During surgery, along the perflorocarbon liquid injection, a full thickness macular developed and perfluorocarbon was accumulated in subretinal space. Perfluorocarbon liquid was then extracted through the macular hole. Postoperatively, ocular coherence tomography confirmed the existence of a full-thickness macular hole. One month later, this macular hole was successfully treated with the use of an Inverted internal limiting membrane flap. Intravitreous liquid PFC injection is a resource to aid in subretineal fluid exit. A number of complications, both intra and postoperative, have been associated with the use of PFC. This is the first reported case of a complete macular hole secondary to PFC injection.

MEDIUM-TERM PERFLUORO-N-OCTANE AS RESCUE POSTOPERATIVE TAMPONADE FOR VERY COMPLEX RETINAL DETACHMENTS: ANATOMICAL AND FUNCTIONAL OUTCOMES

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.

Vitreous Substitutes from Bench to the Operating Room in a Translational Approach: Review and Future Endeavors in Vitreoretinal Surgery

Vitreous substitutes are indispensable tools in vitreoretinal surgery. The two crucial functions of these substitutes are their ability to displace intravitreal fluid from the retinal surface and to allow the retina to adhere to the retinal pigment epithelium. Today, vitreoretinal surgeons can choose among a plethora of vitreous tamponades, and the tamponade of choice might be difficult to determine in the ever-expanding range of possibilities for a favorable outcome. The currently available vitreous substitutes have disadvantages that need to be addressed to improve the surgical outcome achievable today. Herein, the fundamental physical and chemical proprieties of all vitreous substitutes are reported, and their use and clinical applications are described alongside some surgical techniques of intra-operative manipulation. The major upcoming developments in vitreous substitutes are extensively discussed, keeping a translational perspective throughout. Conclusions on future perspectives are derived through an in-depth analysis of what is lacking today in terms of desired outcomes and biomaterials technology.

Vitrectomy for Complicated Retinal Detachment Without the Use of Perfluorocarbon Liquid: A Real-World Data and Retrospective Study

Introduction

This study aimed to evaluate the effectiveness of vitrectomy without using perfluorocarbon liquid (PFCL) for the treatment of complicated retinal detachment (RD).

Methods

The utilisation of PFCL was calculated in four hospitals in 2020 and in one hospital every year from 2012 to 2020. A case series of 320 RD eyes treated with vitrectomy without the use of perfluorocarbon liquid (VWTPL) was followed up for 1–26 months. The rate of retinal reattachment (RR) and postoperative visual acuity (VA, LogMAR) was evaluated. Furthermore, factors influencing RR and VA were analysed.

Results

The overall utilisation of PFCL was 43.87% (42.74%, 45.83%, 62.39% and 4.5%). The annual utilisation was 46.94%, 20.43%, 46.73%, 47.41%, 20%, 17.24%, 7.60%, 10.67% and 4.49% from 2012 to 2020. The VA of 320 eyes improved from 1.96 ± 1.07 preoperatively to 1.43 ± 0.92 (LogMAR, p < 0.001) 1 week post-operation. In the follow-up of 1–26 months (median: 9 months), the primary and final RR was 87.37% and 95.56%, respectively. Age, uveitis, recurrent RD, the number of detached retinal quadrants, aPVR and preoperative VA were considered as the factors influencing postoperative VA. Moreover, preoperative VA and preoperative intraocular pressure were the factors influencing RR.

Conclusion

The utilisation of PFCL varies amongst hospitals with a highest percentage of 62.39%. VWTPL is safe and effective, thereby saving costs and preventing complications related to PFCL.

Trial Registration

ChiCTR-ORC-17014225.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-022-00479-x.

Retinal Detachment Repair With Vitrectomy: Air Tamponade Integration to a Vitreoretinal Service, Comparison With Gas Tamponade, and Literature Review

BACKGROUND AND OBJECTIVE

Rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy and gas tamponade (GT) has significant clinical and quality-of-life impacts compared with repair by short-acting air tamponade (AT). With AT, most authors minimize cryotherapy because of prolonged chorioretinal scar formation and use perfluorocarbon to maximize subretinal fluid drainage; this deviates from traditional technique, which discourages popularization of AT.

PATIENTS AND METHODS

Prospective 12-month study from January to December 2019 of all primary macula-on RRD cases. Patients fulfilling the inclusion criteria for the Pneumatic Retinopexy Versus Vitrectomy for Retinal Detachment Trial received AT and otherwise were assigned to receive GT.

RESULTS

Forty-six patients were enrolled: 22 (48%) receiving AT and 24 (52%) receiving GT. The primary success rate of AT was 21 (95%) and the primary success rate of GT was 23 (96%), with 100% final success. Cryopexy was used in 64% of AT cases and 58% of GT cases. Cataract surgery was required less when AT was used (1 [6%]) than when GT was used (3 [21%]). AT was used in 48% of primary macula-on RRD and 27% of all primary RRD cases.

CONCLUSIONS

AT has visual and anatomical outcomes comparable to those of GT with conventional vitrectomy techniques, with faster postoperative rehabilitation enabling a swift return to normal daily activities. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:87-95.].

Oxygen-Based Nanocarriers to Modulate Tumor Hypoxia for Ameliorated Anti-Tumor Therapy: Fabrications, Properties, and Future Directions

Over the past five years, oxygen-based nanocarriers (NCs) to boost anti-tumor therapy attracted tremendous attention from basic research and clinical practice. Indeed, tumor hypoxia, caused by elevated proliferative activity and dysfunctional vasculature, is directly responsible for the less effectiveness or ineffective of many conventional therapeutic modalities. Undeniably, oxygen-generating NCs and oxygen-carrying NCs can increase oxygen concentration in the hypoxic area of tumors and have also been shown to have the ability to decrease the expression of drug efflux pumps (e.g., P-gp); to increase uptake by tumor cells; to facilitate the generation of cytotoxic reactive oxide species (ROS); and to evoke systematic anti-tumor immune responses. However, there are still many challenges and limitations that need to be further improved. In this review, we first discussed the mechanisms of tumor hypoxia and how it severely restricts the therapeutic efficacy of clinical treatments. Then an up-to-date account of recent progress in the fabrications of oxygen-generating NCs and oxygen-carrying NCs are systematically introduced. The improved physicochemical and surface properties of hypoxia alleviating NCs for increasing the targeting ability to hypoxic cells are also elaborated with special attention to the latest nano-technologies. Finally, the future directions of these NCs, especially towards clinical translation, are proposed. Therefore, we expect to provide some valued enlightenments and proposals in engineering more effective oxygen-based NCs in this promising field in this comprehensive overview.

Comparison of Perfluorodecalin and Silicone Oil as Initial Tamponade for Giant Retinal Tear-Associated Retinal Detachment

INTRODUCTION

To compare visual outcomes and complication rates of giant retinal tear-associated retinal detachment (GRT-RD) cases treated with short-term perfluorodecalin (PFD) tamponade versus silicone oil (SiO).

METHODS

Database analysis of patients with GRT-RD operated on in the period from 1 January 2014 to 31 December 2019.

RESULTS

Forty-five patients were operated for GRT-RD using PFD or SiO during this period. Two children, 7 patients receiving gas tamponade, and 2 lost to follow-up were excluded. Eighteen eyes (40%) received PFD and 27 (60%) received SiO. There were 15/18 (83%) macula-sparing cases in the PFD group and 18/27 (67%) in the SiO group (p = 0.13). The mean duration of oil tamponade was 91 days for SiO and 7.6 days for PFD (p < 0.0001). The mean length of follow-up was 274.5 days for PFD and 668.9 days for SiO. The mean BCVA was 6/18 (63.4 ± 26.0 ETDRS letters) for SiO and 6/12 (72.9 ± 12.7 ETDRS letters) for PFD (p = 0.42). Analysing macula-sparing pseudophakic eyes, the BCVA was 6/12 (67.4 ± 25.9 letters, n = 18) for SiO eyes and 6/9 (76.8 ± 9.9 letters, n = 11) for PFD eyes (p = 0.54). The recurrence rate was 22% (6/27) for SiO and 6% (1/18) for PFD (p = 0.12). The rate of cystoid macular oedema (CMO) was 22% for SiO and 22% for PFD. Epiretinal membrane (ERM) was found in 26% of SiO cases and 22% of PFD cases. Loss of vision after oil removal was not observed. Seven eyes (26%) receiving SiO and none receiving PFD developed chronic ocular hypertension (OHT) (p = 0.02).

CONCLUSIONS

Short-term tamponade with PFD for GRT-RD appears similar to tamponade with SiO in terms of the visual outcomes and complication rates.

Efficacy and Safety of Vitrectomy without Using Perfluorocarbon Liquids and Drainage Retinotomy Associated with Postoperative Positioning Based on Residual Subretinal Fluid for Rhegmatogenous Retinal Detachment

Medical records of 75 eyes from 75 consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) were analyzed. Inclusion criteria were patients with RRD who underwent primary 23- or 25-gauge PPV with air, gas, or SiO tamponade and performed by a single surgeon, no use of perfluorocarbon liquids (PFCL) and drainage retinotomy, and follow-up ≥ six months. Exclusion criteria were patients who underwent previous vitreoretinal surgery, proliferative vitreoretinopathy (PVR) more than grade B, giant tears, and encircling band associated with PPV. The main endpoint was the anatomical retinal reattachment rate after a single surgical procedure. Secondary endpoints were best-corrected visual acuity (BCVA), postoperative retinal displacement, and intraoperative and/or postoperative complications. Primary anatomical success was achieved in 97.3% of cases using this modified surgical procedure. Retinal slippage occurred only in 28.2% of patients and it was not observed in all cases of macula-on RRD. The mean logMAR of the BCVA significantly improved in 92% of patients and no intraoperative complications were observed. The results suggest that complete subretinal liquid drainage is not mandatory for all RRD cases treated with PPV and that using PFCL and performing a drainage retinotomy are not essential in eyes with primary RRD and PVR less than grade B. Postoperative positioning after PPV for uncomplicated RRD based on the presence or absence of residual subretinal fluid at the end of surgery could limit the occurrence of postoperative retinal displacement, while promoting patient compliance.

Vitrectomy with air tamponade and cryotherapy for retinal detachment repair without perfluorocarbon use: A UK 12-month prospective case series

INTRODUCTION

Rhegmatogenous retinal detachment (RRD) is commonly managed by pars plana vitrectomy (PPV). Gas tamponade has significant clinical and quality of life factors that affect the patient. Using shorter acting air tamponade, intuitively leads to surgical concern for higher rate of primary detachment. To circumvent this, surgeons advocate the use of perfluorocarbon to maximise sub-retinal-fluid drainage when using air tamponade and/or avoid using cryotherapy due to longer duration for scar formation relative to laser. These steps are a deviation from traditional technique for otherwise routine primary RRD repair and discourages popularisation of using air tamponade despite the benefits to patients.

METHOD

Prospective 12-month, single centre, single surgeon, consecutive study from January to December 2019. Inclusion criteria was as per based on the pneumatic retinopexy versus vitrectomy for retinal detachment: (i) single retinal break or group of breaks, no larger than 1-clock-hour (30°), in detached retina; (ii) all breaks in detached retina lie above the 8 to 4 o'clock meridian; and (iii) breaks or lattice degeneration in attached retina at any location. We excluded PVR formation and RRD in the inferior 4 o'clock hours.

RESULTS

We report primary and final success rate of 96% and 100%, respectively in 23 eyes (22 macular-on and one macular-off) with RRD eyes in a 12-month period. Cryopexy was utilised in 65% patients and in isolation in 23% with no perfluorocarbon use in all eyes.

CONCLUSION

We show cryotherapy can be used safely in AT-RRD without PFCL in RRD fulfilling PIVOT trial criteria with minimal cataract formation and IOP spikes and faster post-operative visual rehabilitation.

PFOh No: Spontaneous Globe Rupture During Injection of Perfluoro-n-Octane (PFO) During Retinal Detachment Repair

The authors describe a case of spontaneous globe rupture during instillation of perfluoro-n-octane (PFO) during retinal surgery. A 71-year-old male with a macular-involving rhegmatogenous retinal detachment underwent pars plana vitrectomy. During instillation of PFO manually on a single-bore cannula by the assisting resident, spontaneous globe rupture occurred superotemporally in an area with no visible underlying structural abnormalities. Factors that led to this complication include the use of single-bore cannula, error in judgment of resistance during PFO injection, and inexperience. This is the first report of this complication without an identifiable structural abnormality predisposing patient to perforation.

Influence of Perfluorocarbon Liquids on Peripapillary Retinal Nerve Fiber-Layer Thickness Following Pars Plana Vitrectomy with Silicone Oil-Based Endotamponade

Background

Inner retina–layer modifications after pars plana vitrectomy (PPV) can be objectively assessed through spectral domain optical coherence tomography (SD-OCT).

Methods

This study explored prospectively changes in retinal nerve-fiber layer (RNFL) thickness with SD-OCT in eyes undergoing PPV with silicone oil–based tamponade with and without use of perfluorocarbon liquids (PFCLs) during the early postoperative phase (up to 3 months) at the Research Institute of Ophthalmology, Egypt.

Results

Thirty patients were recruited who underwent PPV and silicone oil–based tamponade for either retinal detachment or diabetic retinopathy between April 2019 and September 2019. Mean RNFL thickness showed no significant change during follow-up at the first week (102.90±30.68 mm), 1 month (107.30±32.27), or three months (105.90±36.68; p=0.46, 0.68). There were significant correlations noticed between RNFL thinning and axial length of eyes, intraocular pressure, and use of PFCLs during the follow-up period.

Conclusion

The RNFL tends to change postvitrectomy, but not significantly. Careful examination and consistent follow-up is required for postvitrectomy patients with larger axial length and intraoperative PFCL use.

Posterior Retinotomy vs Perfluorocarbon Liquid to Aid Drainage of Subretinal Fluid During Primary Rhegmatogenous Retinal Detachment Repair (PRO Study Report No. 10)

Purpose:

This work compares posterior retinotomy vs perfluorocarbon liquid (PFCL) for subretinal fluid (SRF) drainage during pars plana vitrectomy for primary rhegmatogenous retinal detachment (RRD).

Methods:

In this large, multicenter, retrospective comparative study, 2620 patients underwent pars plana vitrectomy (with or without scleral buckle) for uncomplicated RRD. Patients for whom SRF was drained via the primary break without retinotomy or PFCL were excluded; those who required both retinotomy and PFCL were similarly excluded. Remaining patients were separated into “retinotomy” and “PFCL” cohorts. Subgroup analysis was conducted for macula-on and macula-off subgroups. Postoperative outcomes were analyzed and compared.

Results:

A total of 760 eyes (82.7%) had retinotomy and 159 eyes (17.3%) had PFCL for drainage of SRF, and baseline characteristics between the 2 groups were similar. Postoperative analysis showed similar outcomes between the retinotomy and PFCL cohorts, including final visual acuity ( P = .19), redetachment rate ( P = .30), anatomic success ( P = .28), presence of postoperative epiretinal membrane ( P = .75), and other macular pathologies ( P > .99). Subgroup analysis yielded similar outcomes for macula-on and macula-off subgroups. Postoperative presence of retained PFCL was 2.4%, possibly a factor in the slightly higher number of subsequent surgical procedures ( P = .03) in the PFCL cohort.

Conclusions:

Postoperative outcomes for retinotomy vs PFCL during RRD repair are comparable, aside from slightly greater number of subsequent surgical procedures needed in the PFCL cohort. Our analysis suggests both techniques are reasonable tools in the repair of macula-on or macula-off RRD.

Chemical compounds causing severe acute toxicity in heavy liquids used for intraocular surgery

Perfluorocarbon liquids (PFCLs) have been considered safe for intraocular manipulation of the retina, but since 2013 many cases of acute eye toxicity cousing blindness have been reported in various countries when using various commercial PFCLs. All these PFCLs were CE marked (Conformité Européenne), which meant they had been subjected to evaluation complying with the International Organization for Standardization (ISO) guidelines. These dramatic events raised questions about the safety of PFCLs and the validity of some cytotoxicity tests performed under ISO guidelines. Samples from toxic batches were analyzed by gas chromatography-mass spectrometry combined with Raman and infrared spectrometry. Perfluorooctanoic acid, dodecafluoro-1-heptanol, ethylbenzene and tributyltin bromide were identified and evaluated by a direct contact cytotoxicity test using ARPE-19 cell line, patented by our group (EP 3467118 A1). Perfluorooctanoic acid at a concentration of >0.06 mM and tributyltin bromide at a concentration of ≥0.016 mM were shown to be toxic, whereas the concentration found in the toxic samples reached 0.48 mM, and 0.111 mM, respectively. These finding emphasized the idea that determination of partially fluorinated compounds are not enough to guarantee the safety of these medical devices.

Use of Perfluorocarbon based Blood Substitute Perftoran in Correction of Hypoxia During Acute Anemia in Animals

The cause of acute and severe hypoxia of the organism is acute posthemorrhagic anemia. To eliminate posthemorrhagic anemia in animals, the perfluorocarbon blood substitute Perftoran (Russia) with a gas-transporting function was used. The aim of this study was to determine the clinical effectiveness of the perfluorocarbon based blood substitute Perftoran with a gas-carrying function in acute posthemorrhagic anemia in animals and reveal possible side effect of the blood substitute and remove them. In the study conducted in the Clinic of Veterinary Medicine of Pushchino Research Center (Russia) participated 20 cats of both sexes, who were admitted with internal bleeding as a result of injuries. The animals were divided into two groups: the control and the treatment groups (10 per group). All animals with anemia were examined according to the standard scheme: anamnesis vitae and anamnesis morbi, physical examination (basic methods of research were used), additional methods that were used: complete blood count (CBC) and biochemical analysis of blood (BA), microscopy of blood smears, abdominal ultrasonography. Based on the obtained results, we can conclude that the use of the gas-carrying substitute for donor blood Perftoran in the treatment group of animals with posthemorrhagic anemia, which resulted from polytrauma, eliminated tissue hypoxia; the treatment of the animals in the control group with standard solutions (by infusing Stabisol) without gas transport correction led to the development of persistent hypoxia, which persisted to the stage of reticulocyte crisis.

Intravitreal methotrexate for the treatment of proliferative vitreoretinopathy

Background/aims

Preventing and treating proliferative vitreoretinopathy (PVR) remain a serious challenge for vitreoretinal surgeons. PVR is a devastating complication of retinal detachment that results in recurrent detachment and limits visual recovery. At present, there is no effective treatment for PVR.

Materials and methods

A retrospective review was performed on a cohort of five consecutive eyes with severe PVR and recurrent retinal detachment that were treated with relaxing retinectomy, extended perfluorocarbon liquid tamponade (4–5 weeks) and a series of intravitreal methotrexate (MTX) injections (100–200 µg/0.05 mL for 10 weeks).

Results

All five patients remained reattached (100%) with 11–27 months of follow-up (mean = 17.4). 4 eyes recovered ambulatory vision (>20/200) with normal intraocular pressure and non-fibrotic laser scars along with the relaxing retinectomy. The initial patient remained reattached, but only had hand motions vision. The only adverse effect noted was mild superficial punctate keratopathy in one patient.

Conclusion

This small, retrospective study suggests that a series of MTX injections may be beneficial for treating complex retinal detachment caused by PVR. Further study is indicated.

Autologous Retinal Transplant for Refractory Macular Holes: Multicenter International Collaborative Study Group

PURPOSE

To report the structural and functional outcomes of autologous neurosensory retinal transplant for closure of refractory large macular holes (MHs).

DESIGN

Multicenter, retrospective, consecutive case series.

PARTICIPANTS

A total of 41 eyes of 41 patients with a full-thickness MH refractory to prior vitrectomy with internal limiting membrane (ILM) peel and tamponade.

METHODS

All patients underwent pars plana vitrectomy, autologous neurosensory retinal transplant with gas, silicone oil tamponade, or short-term perfluoro-n-octane heavy-liquid tamponade. All patients had at least 6 months' follow-up.

MAIN OUTCOME MEASURES

Anatomic closure of MH, change in ellipsoid zone (EZ) and external limiting membrane (ELM) defect on OCT, visual acuity (VA) recovery, and surgical complications were analyzed.

RESULTS

Mean number of prior surgeries was 1.5±0.94 (range, 1-3), and patients were followed for a mean of 11.1±7.7 months (range, 6-36 months). Complete anatomic closure of MH by OCT was achieved in 36 of 41 eyes (87.8%). Mean corrected VA (logarithm of the minimum angle of resolution [logMAR]) improved (P = 0.03) from 1.11±0.66 (range, 0.48-3) to 1.03±0.51 (range, 0.1-2) at the last postoperative visit. The VA improved (≥0.3 logMAR units) in 15 eyes (36.6%), was stable in 17 eyes (41.5%), and worsened in 9 eyes (21.9%). Among eyes with anatomic closure, VA improved in 52.3% and worsened in 13.8%, whereas in those without closure, VA worsened in 40% and improved in none. Mean preoperative largest basal diameter was 1468.1±656.4 μm (range, 621-2600 μm), and mean inner-opening diameter was 825±422.5 μm (range, 336-1649 μm). Mean preoperative EZ defect was 1777.3±513.8 μm (range, 963-2808 μm), which decreased to 1370±556.9 μm (range, 288-2000 μm) at final follow-up (P = 0.007). Mean preoperative ELM was 1681.5±429 μm (range, 1172-2606 μm), which decreased to 1408.5±571.2 μm (range, 200-2000 μm) at final follow-up (P = 0.017). Major postoperative complications were retinal detachment (n = 1) and vitreous hemorrhage (n = 1). There were no cases of proliferative vitreoretinopathy, endophthalmitis, suprachoroidal hemorrhage, or choroidal neovascularization.

CONCLUSIONS

The autologous retinal transplant technique offers a high degree of anatomic success and proved safe in this initial experience for closure of refractory MHs.

MANAGEMENT OF GIANT RETINAL TEARS USING TRANSSCLERAL DIODE LASER RETINOPEXY AND SHORT-TERM POSTOPERATIVE TAMPONADE WITH PERFLUORO-N-OCTANE

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.

Designing Liquid-Infused Surfaces for Medical Applications: A Review

The development of new technologies is key to the continued improvement of medicine, relying on comprehensive materials design strategies that can integrate advanced therapeutic and diagnostic functions with a variety of surface properties such as selective adhesion, dynamic responsiveness, and optical/mechanical tunability. Liquid-infused surfaces have recently come to the forefront as a unique approach to surface coatings that can resist adhesion of a wide range of contaminants on medical devices. Furthermore, these surfaces are proving highly versatile in enabling the integration of established medical surface treatments alongside the antifouling capabilities, such as drug release or biomolecule organization. Here, the range of research being conducted on liquid-infused surfaces for medical applications is presented, from an understanding of the basics behind the interactions of physiological fluids, microbes, and mammalian cells with liquid layers to current applications of these materials in point-of-care diagnostics, medical tubing, instruments, implants, and tissue engineering. Throughout this exploration, the design parameters of liquid-infused surfaces and how they can be adapted and tuned to particular applications are discussed, while identifying how the range of controllable factors offered by liquid-infused surfaces can be used to enable completely new and dynamic approaches to materials and devices for human health.

BLINDNESS RELATED TO PRESUMED RETINAL TOXICITY AFTER USING PERFLUOROCARBON LIQUID DURING VITREORETINAL SURGERY

PURPOSE

To describe the presumed retinal toxicity after using specific batches of perfluorocarbon liquid ALA OCTA (Alamedics, Dornstadt, Germany) in pars plana vitrectomy.

METHODS

This is an observational retrospective consecutive case series analyses of patients operated on pars plana vitrectomy for retinal detachment or intraocular lens subluxation, using the 150141 or 200114 batches of perfluorocarbon liquid ALA OCTA as assistance during the surgery in a single center. Patients were included in this report if they manifested retinal toxicity signs throughout the follow-up, such as retinal and retinal pigment epithelium atrophy, disk paleness, and intensive macular fibrosis. Spectral domain optical coherence tomography (Spectralis; Heidelberg Engineering, Heidelberg, Germany) and Ultra-Wide Field 200° retinal camera (Optos P200Tx; Optos, Scotland, United Kingdom) images, electrophysiological tests, and visual fields were performed to analyze the retinal structure and functionality.

RESULTS

Seven of 80 patients showed all the described signs of toxicity, after a mean follow-up of 34.29 days (range: 10-87) since surgery. Four patients needed a second pars plana vitrectomy because of tractional retinal detachment and proliferative vitreoretinopathy, and two of them underwent a third surgery because of redetachment. All patients experienced amaurosis or central scotoma, with a final best-corrected visual acuity ranging from 20/200 to light perception.

CONCLUSION

Presumed toxic batches of perfluorocarbon liquid may cause massive retinal toxicity. A rapid suspicion, a correct traceability of surgical products, and informing health authorities are fundamental to prevent further cases of toxicity.

Reversible Corneal Toxicity of Retained Intracameral Perfluoro-n-octane

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.

Short-Term Vitreoretinal Tamponade with Heavy Liquid Following Surgery for Giant Retinal Tear

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.

Optical Coherence Tomography Angiography Characteristics of Fovea in Residual Subfoveal Perfluorocarbon Liquid Eye

The authors report a case of optical coherence tomography angiography (OCTA) features of retina and choriocapillaris before and after the surgical removal of a subfoveal perfluorocarbon liquid (PFCL) bubble. Before the surgery, the fovea avascular zone (FAZ) of both superficial and deep inner retinal layers (SRL/DRL) dramatically enlarged. However, after the removal, the FAZ continually decreased in both layers, even becoming close to normal in size. The abnormal choriocapillaris dark areas were also undetectable. Before and after surgery, the angle of the maximum FAZ diameter constantly remained horizontal and within normal limit in the SRL, forming an oval-shaped FAZ. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1062-1066.].