Heavy tamponade 2 Densiron 68® in routine clinical practice: anatomical and functional outcomes of a consecutive case series

Abstract

Purpose To evaluate the safety and efficacy of Densiron 68 s 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 reattachment of the retina, defined as retinal reattachment 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 ¼ 72:49), (R/L ¼ 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 reattachment 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 ¼ 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.

Clinical complications of Densiron 68 intraocular tamponade for complicated retinal detachment

“…A higher rate of rise in IOP could be noted in 8-30% patients with Densiron 68 tamponade. 11,18,21,22 This was similar to the results of our study, in which we reported that the incidence of elevated IOP after Densiron 68 tamponade was 18.5%. At 1 week and 1 month after heavy oil operation, five patients presented with an IOP higher than 30 mmHg, and at study end, 3 months after oil removal, no patient had raised IOP higher than 20 mmHg.…”

“…Similar results were obtained in large studies involving 99 and 121 cases. 18,21 With Densiron 68, dispersion occurred in 16 (6/42) and 15% (7/48), 11,19 remarkable emulsification encountered in 16.7 (2/12) and 10% (1/10) after 1-year follow-up. 12,22 Only one of the cases described by Sandner and Engelmann 19 had increased IOP; nevertheless, the authors recommend anterior chamber washout in all patients at the time of Densiron 68 removal.…”

“…However, in contrast to these results, there were a few studies indicated relatively low rates of intraocular inflammations, in which it has been reported that the incidence of intraocular inflammations ranges from 7.1 to 13.1%. 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.…”

Oxane HD and Retinal Detachment Surgery in Routine Clinical Practice

“…However, in eyes with scleral buckling, endotamponade with Oxane HD was found to have low retinal reattachment success rates (26%); the authors suggest that this may be due to poor affinity to the retinal surface, or insufficient specific density to provide adequate tamponade to areas adjacent to the indent [7]. The retinal reattachment rate with Densiron 68 endotamponade was 33–91% after the initial procedure, and 75–94% with further surgery [11,12,13,14,15,16,17]. It had been observed that Densiron 68 enabled better anatomic reattachment for complicated RD when compared to conventional 5,000-cs silicone oil, but adverse effects were similar [14].…”

Long-Lasting Endotamponades in Vitreoretinal Surgery

“…Several reports and studies on the use of Densiron 68 in complicated retinal detachment have been published in the last few years [66,67,68,69,70,71,72,73,74,75,76,77]. Primary anatomical outcome rates have varied between 33 and 91%, with final anatomical success rates varying between 75 and 94%.…”