Long-Term Vitreous Replacement with Perfluorohexyloctane and Silicone Oil: Preliminary Reports of a Multicentric Study

Abstract

Aim: To report on the use of a combined intra-ocular tamponade with silicone oil and perfluorohexyloctane (F₆H₈) in the treatment of complex retinal detachment. Design: A prospective consecutive interventional case series from seven study centres. Participants: 69 patients presenting a retinal detachment with proliferative vitreoretinopathy (PVR) and retinal breaks of the inferior two quadrants of the fundus. Method: Patients were divided into two groups: (1) 28 eyes which had not been operated on before; (2) 41 eyes affected by recurrent retinal detachment that had had unsuccessful previous surgery with silicone oil or gas tamponade. A pars plana vitrectomy, membrane peeling and – when necessary – a retinotomy were performed; the vitreous cavity was filled with two thirds of F₆H₈ and one third of silicone oil 1,000 mPas (double filling, DF). The endotamponade was removed after 30–45 days (median 38) and replaced by balanced salt solution or silicone oil according to the condition of the retina. Results: Retinal reattachment was achieved in 52 out of 69 cases (75%) 6 months after removal of the DF without any endotamponade. Conclusion: The DF with F₆H₈ and silicone oil allows a good endotamponading to the inferior retina and the posterior pole. The DF appeared to be well tolerated. Further studies are necessary to evaluate whether a DF is advantageous in respect to silicone oil filling alone in case of retinal breaks and PVR of the inferior retina.

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

“…With a follow-up of 10 months, the results of this study are encouraging with fewer complications compared to the use of F6H8 alone. In a multi-centre study, Rizzo et al 33 used the sequential Heavy tamponade 1: a review H Heimann et al injection of 30% F6H8 and 70% 1000 cSt silicone oil in a total of 68 patients. The tamponade was removed after a mean of 40 days with a follow-up of 6 months after tamponade removal.…”

“…Patients with RRD not complicated by PVR mainly consist of those with breaks or tears in the lower fundus periphery. The largest subgroups are patients with giant tears 5,11,17,20,33,34 or large, multiple, and posterior breaks. [20][21][22]27,32,33 Another subgroup is myopic patients with RRD associated with a macular hole, a posterior staphyloma, or recurrent macular holes.…”

“…The largest subgroups are patients with giant tears 5,11,17,20,33,34 or large, multiple, and posterior breaks. [20][21][22]27,32,33 Another subgroup is myopic patients with RRD associated with a macular hole, a posterior staphyloma, or recurrent macular holes. 11,12,21,26,34,35,50 Uncommon indications that were included into clinical trials as single cases only were tractional RD associated with diabetic retinopathy, 6,11,14,15 hypotony, 11 and retinal necrosis.…”

“…55,56 In most series, an air-heavy tamponade exchange was the preferred method. 11,21,22,[32][33][34][35] If larger retinotomies are present, this might be complicated by slippage of the retinotomy edge; in such cases, a heavy liquid-heavy tamponade exchange can be performed, as an interface between the heavy liquid and the heavy tamponade becomes visible. 57 Using Oxane HD, Wolf et al 20 preferred this approach in the majority of cases.…”

“…21 On the other hand, some authors achieved excellent results with additional buckling. 33 No definite recommendation can be given based on the currently available literature; however, it seems that an additional scleral buckle is not essential to achieve a successful outcome with heavy tamponades.…”