Emulsification of Densiron-68 used in inferior retinal detachment surgery

Abstract

Purpose To report the clinical features of eight patients presenting with emulsification of the heavier than water vitreous substitute, Densiron-68. Methods Two patients underwent primary inferior retinal detachment (RD) surgery, two patients underwent giant retinal tear repair, three patients had repair of inferior RD complicated by proliferative vitreoretinopathy and one patient had inferior RD surgery following repair of a scleral rupture. All patients had insertion of Densiron-68. Results Significant emulsification of Densiron-68 was seen within 12 weeks of surgery in eight cases out of a total of 40 patients receiving Densiron-68. Conclusion Despite adequate Densiron fills, emulsification necessitated its removal. Emulsified Densiron may have contributed to significant intraocular inflammation, epiretinal membrane formation and cystoid macular oedema. Without removal, prolonged presence of emulsified Densiron may lead to keratopathy, secondary glaucoma and retinal toxicity secondary to partitioning of perfluorohexyloctane. This has potentially significant implications on the indications for Densiron-68 use and warrants consideration before deciding on the optimal surgical intervention for inferior RDs.

Clinical complications of Densiron 68 intraocular tamponade for complicated retinal detachment

“…11,21,22 All cases could be controlled with topical anti-inflammatory therapy. Majid et al 14 reported a single case of fibrinous uveitis associated with Densiron 68. Factors predisposing to fibrin reaction include multiple surgical procedures, such as retinokryopexy, excessive endolaser photocoagulation, large retinotomy, diabetes, and internal tamponade (especially silicone oil).…”

“…11,12 However, significant problems have also been reported with the use of these newer substances. 13,14 In this study, we evaluated deeply postoperative complications in patients after Densiron 68 intraocular tamponade for complicated RD.…”

Heavy tamponade 1: a review of indications, use, and complications

“…21,22 However, significant problems have also been reported with the use of these newer substances. 26,27,52 It is difficult and often impossible to distinguish between problems caused by the tamponade and those that are associated with the underlying complicated retinal disease. Emulsification, for example, is certainly related to the physical and chemical properties of the tamponade substance.…”

“…21,25,26 However, several reports reporting serious side effects or disappointing results have also been published. 26,52 Densiron 68 has been chosen as the heavy tamponade of choice in the 'Heavy Silicone Oil Study' (HSO Study), the first multi-centre comparative trial of a heavy vs conventional silicone oil tamponades. 54 HWS 46-3000 is the latest, heaviest and most viscous of the three new tamponades; a clinically significant emulsification could not be observed in the first clinical application of HWS 46-3000 when left in situ for 1-3 months and the initial report with low complication and high success rates are encouraging.…”

“…Densiron 68 has been investigated in several clinical series (Table 1), predominantly in patients with complicated RRD. 21,[24][25][26]52,53 Densiron 68 was removed after 2-3 months. It seems to be more stable and better tolerated than F6H8.…”