黄斑区内界膜剥除联合38G套管针应用治疗黄斑区视网膜下全氟萘烷残留的疗效

目的：观察黄斑区内界膜(ILM)剥除联合38G套管针应用治疗黄斑区视网膜下全氟萘烷残留的疗效。
　　方法：选取来自厦门眼科中心2008-01/2013-10期间的29例29眼视网膜复位良好、但黄斑区视网膜下全氟萘烷残留的患者,分为A组、B组。 A组14例14眼,取出硅油后,直接以38 G套管针吸除黄斑区视网膜下全氟萘烷液体,术闭填充过滤空气。 B组15例15眼,取出硅油后,染色并完整剥除黄斑区ILM,范围约4PD,以38G套管针吸除黄斑区视网膜下全氟萘烷液体,术闭填充过滤空气。所有病例如在术后1 wk复查OCT发现黄斑裂孔形成者,均再行气液交换,填充16% C3 F8气体。观察两组病例术后4,8,24 wk最佳矫正视力( BCVA )变化,复查OCT观察黄斑区视网膜下全氟萘烷液体有无残留、有无黄斑裂孔形成及黄斑区形态变化等。
　　结果：两组术后 4, 8, 24 wk 的 BCVA 均有提高, B 组的BCVA提高值优于A组( P<0.05)。 A 组术后24 wk 有7例(50%)黄斑裂孔形成,黄斑区无全氟萘烷残留。 B组术后24 wk 1例(7%)黄斑裂孔形成,黄斑区无全氟萘烷残留。
　　结论：黄斑区内界膜剥除联合38 G套管针应用治疗黄斑区视网膜下全氟萘烷残留的方法可以彻底吸除黄斑区视网膜下全氟萘烷,较少出现黄斑裂孔,该方法安全、有效、微创,有效保护了黄斑区视功能。     

Endophotocoagulation through perfluorodecalin in rabbit eyes

Retinal laser endophotocoagulation through perfluorodecalin was studied in six eyes of three Dutch-belted rabbits after vitrectomy. Both the energy density threshold (EDT/50) and the energy threshold necessary to obtain a therapeutic lesion were evaluated. Both argon and semiconductor diode laser endophotocoagulators were used. The amount of laser power energy and the histology of chorioretinal lesions were similar when photocoagulating through perfluorodecalin, compared to photocoagulation through balanced salt citrate-buffered solution. This experimental study indicates that no extra care is necessary when retinal endophotocoagulation is performed through perfluorodecalin, as long as circular spots are obtained and energy is delivered symmetrically to the target site.     

Effect of perfluorodecalin on human retinal pigment epithelium and human corneal endothelium in vitro

· Background:Perfluorocarbon liquids are useful intraoperative tools in complicated vitreoretinal surgery. They are usually removed at the end of the procedure, but small amounts may remain in the eye. Recently, contradictory results have been reported on the damage in association with residual perfluorocarbon liquids in the eye. This study examined the effects of perfluorodecalin on human retinal pigment epithelium and corneal endothelium in vitro. · Methods:Vitality and proliferative capacity of cell cultures were measured after incubation with perfluorodecalin. Vitality of cell cultures were measured using the Life-Dead assay. Cell proliferation was determined by measuring incorporation of 5-bromo-2’-deoxyuridine into cellular DNA. Furthermore, endothelium of organ-cultured human corneas was examined after incubation with perfluorodecalin by photodocumentation. · Results:Both cell types showed less extinctions in the Life-Dead assay after incubation with perfluorodecalin. After removing perfluorodecalin from the cultures, cells showed the same capacity of proliferation as the control cells. Compared to control corneas, perfluorodecalin induced a decrease in endothelial cell density. In four corneas, endothelial cell necrosis was observed. · Conclusion:Decreasing extinctions in the Life-Dead assay after incubation with perfluorodecalin can be interpreted as showing a decreasing amount of vital cells. Because cell proliferation showed no significant changes the results suggest that perfluorodecalin may not be directly toxic to cells in vitro. It may exert an indirect or mechanical effect on cell function by impeding the normal metabolic exchange between endothelium and medium. Based on these results perfluorodecalin should be completely removed after operation. Received: 3 November 1998 Revised version received: 12 April 1999 Accepted: 28 June 1999     

国产全氟萘烷及全氟丙烷联合应用治疗早期视网膜巨大裂孔

目的 探讨保留晶体及非硅油填充治疗早期视网膜巨大裂孔的方法。方法 联合应用全氟丙烷和全氟萘烷治疗１３例巨大裂孔性视网膜脱离。结果 视网膜最终复位率９２．３％,视力显著提高。结论 在治疗早期巨大裂孔性视网膜脱离时,联合应用全氟萘烷及全氟丙烷,保留晶体,不行硅油填充,有助于获得较高手术成功率并提高视力。     

Pathogenesis of retinal detachment associated with morning glory disc

Pars plana vitrectomy was performed on a six-year-old boy with complete retinal detachment associated with a morning glory disc of his left eye. Perfluorodecalin was injected to unfold the retina. During surgery, perfluorodecalin leaked repeatedly under the retina. This case demonstrates that a retinal hole in tissues lying within the optic disc anomaly provides a communication for fluid and perfluorodecalin between the subretinal space and vitreous cavity resulting in a rhegmatogenous retinal detachment in the morning glory syndrome.     

Subretinal perfluorodecalin toxicity

Background: Subretinal injection of perfluorocarbon liquids (PFCL) can occur during vitreoretinal surgery. The long-term effects of this complication are not well established. Methods: A case report is presented of a patient with retained subretinal perfluorodecalin following retinal detachment repair for a giant retinal tear. Results: In the early postoperative period, the macular retinal pigment epithelium (RPE) became opalescent in appearance and by 2 months postoperatively the patient developed macular RPE atrophy with resulting poor central vision. Conclusions: Toxicity of subretinal perfluorodecalin causing RPE atrophy is proposed. We recommend all traces of PFCL should be removed if possible.     

Treatment of complicated retinal detachment. Intraoperative use of perfluorodecalin]

Perfluorodecalin was injected into the vitreous cavity of 36 eyes during vitreous surgery for complicated retinal detachment. This low-viscosity liquid is immiscible with water, chemically inert and has a high specific gravity. In all cases the posterior retina was flattened without the need for a posterior retinotomy for drainage of subretinal fluid. Injection of the fluid caused stabilization of the retina and improved removal of peripheral epiretinal membranes. In 1 case a retinal break occurred during injection of the liquid and perfluorodecalin entered the subretinal space. In 4 eyes a small mobile droplet of residual perfluorodecalin was observed post-operatively. During follow-up periods of up to 11 months no retinal changes caused by the residual liquid were observed.     

Perfluorodecalin-induced intravitreal inflammation.

OBJECTIVE: To report an unusual case of intravitreal inflammation in a human eye caused by the presence of residual perfluorodecalin in a case of giant retinal tear and retinal detachment. METHODS: The posterior capsule of the lens, which was infiltrated with deposits, was collected during surgery. The specimen was stained with hematoxylin and eosin, with periodic acid-Schiff, and for melanin. Part of it was examined with electron microscopy. Immunohistochemical staining was performed to demonstrate CD68 antigens, cytokeratin, and glial fibrillary acid protein. RESULTS: Vacuolated macrophages and retinal pigment epithelial cells infiltrated the posterior capsule. Electron microscopy showed the presence of membrane-lined vacuoles within the macrophages. A monolayer of epithelial cells covered the cellular infiltration. CONCLUSION: Residual perfluorodecalin can induce an intraocular chronic macrophage response.     

保留晶状体的玻璃体视网膜手术治疗巨大视网膜裂孔

目的探讨保留透明晶状体的玻璃体视网膜手术治疗伴有增生性玻璃体视网膜病变(proliferativevitreoretinopathy,PVR)的巨大视网膜裂孔(giant retinal tears,GRT)的手术方法及效果。方法对1997年7月至 1999年7月间30例GRT患者的31只患眼作回顾性分析。手术方法包括三通道睫状体平部玻璃体切割、膜剥离、视网膜切开与切除、全氟萘烷使用、眼内激光光凝、硅油或C₂F₆气体 填充。术中28只眼保留透明晶状体,术后追踪时间11～34个月(平均12.5个月)。结果GRT视网膜完全解剖复位29只眼,部分复位1 只眼,有效率为96.8%。硅油填充27只眼,平均6.0个月后行硅油取出,追踪6～19个月,26只眼视网膜全部复位,1只 眼失败。3只眼行白内障手术摘除,最终保留晶状体25只眼,其中并发晶状体后囊轻度混浊16 只眼。24只眼术后视力提高,占77.4%, 最好的矫正视力0.4。结论保留晶状体的玻璃体切割联合应用全氟萘烷液体及硅油填充可有效的提高伴有PVR的GRT 手术成功率及视力。(中华眼底病杂志,2001,17:93-95)     

Corneal toxicity and inflammation secondary to retained perfluorodecalin

PURPOSE: To describe a case with bullous keratopathy and anterior segment inflammation associated with heavy liquids. DESIGN: Observational case report. METHODS: Review of clinical and histopathologic changes. RESULTS: A 65-year-old patient underwent a pars plana vitrectomy for a rhegmatogenous retinal detachment. Perfluorodecalin was used as a temporary retinal tamponade. After surgery, bubbles of heavy liquid were noted in the anterior chamber. Fifteen months later, severe corneal edema developed, associated with corneal vascularization and keratic precipitates. Removal of heavy liquid through a paracentesis was attempted but the cornea remained edematous, and a penetrating keratoplasty was performed. In the histopathologic examination inflammatory changes from retention of perfluorodecalin were observed. There was a decompensated cornea with florid bullous keratopathy, inflammatory infiltration with vascularization, and deposition of perfluorodecalin within keratocytes and perivascular macrophages. CONCLUSION: Presence of heavy liquids in the anterior chamber may be associated with an intense inflammatory response and corneal decompensation.     

Low viscosity liquid fluorochemicals in vitreous surgery

Low viscosity liquid fluorocarbons have physical properties potentially useful as intraoperative adjuncts during vitreous surgery for complicated retinal detachments. These substances are optically clear, have specific gravity greater than that of water, and interfacila tension properties similar to those of silicone oil. In four patients who had complicated retinal detachments I used perfluorotributylamine and perfluorodecalin during vitreous surgery. Two giant retinal tears were flattened intraoperatively without turning the patient into the prone position. In two patients with severe proliferative vitreoretinopathy, perfluorotributylamine allowed adequate retinal tamponade and avoided a posterior retinotomy for internal drainage of subretinal fluid. Endophotocoagulation was applied.     

全氟萘烷液体在前房中的长期临床观察

目的 观察玻璃体视网膜手术中应用过氟化碳液体后在前房中残留的小滴长期影响。方法 观察组有９例（９只眼），均为复杂性视网膜脱离玻璃体视网膜手术后，在前房内残留全氟萘烷液体的患者。手术方法较玻璃体切除联合巩膜扣带技术，包括三通道睫状体平部晶状体／玻璃体切除、膜剥离、全氟萘烷液体使用、眼内激光、硅油－全氟萘烷液体变换或气体－全氟萘烷液体交换。平均随访１０．３ｍｏ。结果 ９例患者术后前房中发现全氟萘烷液体     

Retinal detachment and degeneration in response to subretinal perfluorodecalin in rabbit eyes

Perfluorocarbon liquids, including perfluorodecalin (PFD), are useful intraoperative tools in complicated vitreoretinal surgery, such as for giant retinal tears, PVR and intraocular foreign bodies. Due to its high specific gravity (1.91 g/cm³) subretinal complications of PFD may occur. The consequences of subretinal PFD were studied in 23 albino rabbits (28 eyes). Using glass micropipettes (outer diameter of tip 100–120 qm), we injected 50–100 l PFD subretinally via the vitreous space. The same volume of BSS was injected into 18 control eyes. Eyes were monitored by indirect ophthalmoscopy and examined by light and electron microscopy at 1, 2 and 3 days, and 1, 2, 4 and 12 weeks. Progressive retinal detachments with newly formed retinal breaks in the inferior quadrants developed in 26 of 28 eyes. As early as 1 day postoperatively, subretinal PFD induced loss of outer and inner segments. Local retinal necrosis occurred in 4 eyes 5–7 days after surgery. A marked vacuole formation in retinal layers and PFD emulsification were regularly seen. The control eyes healed spontaneously. Toxic, mechanical and barrier effects may have caused the retinal damage. We advocate that all PFD be removed from the eye at surgery.Presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology, Sarasota, Florida, May 8, 1992     

视网膜切开与切除术在复杂性视网膜脱离手术中的应用

目的探讨视网膜切开与切除术在复杂性视网膜脱离手术中的临床应用。方法对１９９７年９月至１９９８年１２月间行视网膜切开与切除的２４例复杂性视网膜脱离患者作回顾性分析。其中巨大裂孔性网脱１５例,外伤牵引性视网膜脱离２例,增殖性血管性视网膜病变２例,复发性视网膜脱离３例,前部ＰＶＲ２例。手术联合玻璃体切除联合巩膜扣带技术,三通道睫状体平部晶体／玻璃体切除、膜剥离、过氟化碳液体使用、眼内激光、硅油－过氟化碳液体交换填充硅油或气体－过氟化碳液体交换填充Ｃ２Ｆ６气体。其中采用视网膜切开１０例,视网膜切除１０例,视网膜切开联合切除４例。结果２４例患者近期（出院时）观察视网膜解剖复位２２例,有效率为９１．７％,１９例视力不同程度的改善。１５例巨大裂孔僵硬边缘切除或裂孔两边松驰性视网膜切开,解剖复位１４例,视力改善。术后随访１９例,时间为３～１４月（平均６月）,视网膜复位１８例,占９４．７％,视力≥０．０５者９例,占５０％,眼球萎缩及低眼压１例。结论视网膜切开与切除术提高了复杂性视网膜脱离手术的成功率。     

Quantification of intraocular retained perfluorodecalin after macroscopic complete removal

· Background: A study was performed to determine the amount of intraocular retained perfluorodecalin after macroscopic complete removal. · Material and methods: Freshly enucleated pig eyes had the anterior segment removed, vitrectomy was carried out, and the eye cups were placed in 0.9% buffered saline solution. One millilitre of perfluorodecalin was instilled for 30 min, followed by a fluid-air exchange. Perfluorodecalin was macroscopically removed. The retina was rinsed twice with 0.9% buffered saline solution. In a second group no rinsing was done, while in a third group no fluid-air exchange was performed. Finally all eye cups were filled with 2.0 ml of the perfluoropolyether Hostinert 130 to dissolve retained perfluorodecalin. The quantity of perfluorodecalin in perfluoropolyether was determined by gas chromatography. · Results: Retained perfluorodecalin was detected in all experiments. The smallest portion of perfluorodecalin retained (range 0.04–0.08, mean 0.058%, SD ±0.015%) was observed without fluid-air exchange. After fluid-air exchange the portion with rinsing was 0.11–0.27% (mean 0.21%, SD ±0.059%) and that without rinsing was 0.51–0.69% (mean 0.60%, SD ±0.065%). · Conclusions: Even after macroscopic complete removal of perfluorodecalin a thin layer remains on the retina. If intraoperative fluid-gas exchange is necessary, multiple rinsing with 0.9% buffered saline solution should be performed to reduce the amount of perfluorocarbon liquid retained. Received: 4 November 1997 Revised version received: 22 January 1998 Accepted: 27 February 1998     

Use of perfluorocarbon solutions in the surgical treatment of posterior luxation of the lens]

Posterior lens dislocations represent 20 to 40% of all lens dislocations. It can occur after trauma. Visual prognosis can be good, but most often there are complications such as glaucoma, retinal detachment and uveitis. A few years ago, surgery was difficult, and surgery was delayed until the development of specific complications. A new technique, using perfluorocarbon liquids (PFCL), should be recommended because it is simple, and constantly effective. After vitrectomy, perfluorodecalin is injected into the vitreous cavity. As PFCL have a density twice the density of water, it allows the lens to float on the surface of the PFCL, behind the iris. Lens extraction can be associated with trabeculectomy, and anterior chamber lens implantation. We present a prospective study of 6 cases operated according to this technique. Postoperative results were good: visual acuity was preserved and ocular tension was controlled in cases of preoperative hypertonia. We believe this technique can be recommended after posterior lens dislocation, to prevent complications and to preserve visual acuity.     

The effect of chemical stability and purification of perfluorocarbon liquids in experimental extended-term vitreous substitution

Background: To determine the importance of chemical stability and purification of perfluorocarbon liquids (PFCLs) in experimental retinal tolerance, we tested four different substances as long-term vitreous tamponade: purified and nonpurified perfluorodecalin (PFD) and perfluoro-octylbromide (PFOB) Method: After mechanical vitrectomy we replaced the vitreous of 65 rabbit eyes. Five groups were formed; four of them received the four PFCLs, while one served as control and received Ringer solution. The eyes were observed clinically every week and examined histologically after 1, 2, 4 and 8 weeks Results: After 1 week we observed foam cells and intraretinal macrophages in all eyes with PFCLs. Purified PFD caused retinal lesions in the photoreceptor, ganglion cell and outer nuclear layers after only 2 weeks in the lower part of the eyes. In eyes filled with purified PFOB we observed more pronounced damage of the same nature. Unpurified substances caused severe inflammation and retinal detachment Conclusion: Our study demonstrates that purification and chemical stability are important factors in retinal tolerance of PFCLs for vitreous replacement. Although purified PFD was tolerated by the rabbit eyes for 1 week, we cannot recommend this substance for short-term clinical use as a vitreous substitute.     

Failure of potassium siphoning by Müller cells: a new hypothesis of perfluorocarbon liquid-induced retinopathy

PURPOSE: To determine the effect of perfluorocarbon liquid (PFCL)-induced abolition of potassium siphoning by the vitreal end feet of Miller cells. METHODS: Porcine eyecups were filled with stained balanced salt solution and PFCLs (perfluorodecalin, perfluorooctane, perfluoroperhydrophenanthrene or the semifluorocarbon perfluorohexylhexane). With optical coherence tomography, the distance between PFCL and retina was determined, and the size of the aqueous space covering the retinal surface was estimated. The data were used to calculate the retinal potassium siphoning into small aqueous volumes. RESULTS: The distance between PFCL and retinal surface was found to be less than 5 to 10 microm with any PFCL tested. The resultant volume of the aqueous space was too small to act as a sufficient sink for K+ ion siphoning. CONCLUSIONS: A certain threshold volume of vitreal fluid seems to be necessary for efficient buffering of intraretinal increases of K+ and perhaps other (e.g., H+) ions through the Müller cells. When the aqueous fluid is replaced by a PFCL (or by silicone oil) for longer periods, the outer retina becomes subject to long-lasting K+ accumulation, and consequent neurodegeneration and reactive gliosis occurs. The authors propose to search for new vitreous-substituting fluids with the capability to dissolve ions.     

Effect of gravity in long-term vitreous tamponade: in vivo investigation using perfluorocarbon liquids and semi-fluorinated alkanes

Purpose In order to investigate whether gravity is the reason for retinal degeneration in long-term vitreous tamponade, perfluorohexyloctane (F6H8), perfluorodecalin (PFD), and a mixture of F6H8/PFD were compared. Materials and methods Each group of 5 rabbits received a 3-month tamponade with either PFD (pure) (1.93 g/cm³), F6H8 (pure) (1.33 g/cm³), or a 1:1 mixture of F6H8/PFD (1.62 g/cm³). Electroretinograms (ERG) were performed pre- and postoperatively. Lower and upper retinal areas were compared using immunohistochemical methods. Transmission electron microscopy was performed to investigate alterations in the photoreceptors. Results All three substances were tolerated well in rabbit eyes for up to 3 months. Dispersion was seen earliest with PFD and latest with pure F6H8. None of the substances demonstrated inflammatory reactions or vascular alterations. ERGs were not considerably altered with any of the substances. Histology of the retina showed alterations in the cell counts within the inner and outer nuclear layer that were not attributable to the gravity of the tamponading agent. Conclusion In contrast to previously published work, this study did not detect any tamponade-related structural damage of the retina after a 3-months tamponade in the rabbit model. Based upon this study, we conclude that gravity might not be causally linked to retinal damage. W. Hiebl and H. Meinert are employees of Fluoron. All other authors have no financial interest in the data presented.     

Exchange of perfluorodecalin for gas or oil: a model for avoiding slippage

• Background: The introduction of liquid perfluorocarbons as an intraoperative tool has greatly facilitated retinal re-apposition in giant retinal tears (GRT) and relieving retinotomies (RR). Slippage of the retina can occur during the exchange of heavy liquids for oil or gas, especially if the fill of perfluorocarbons is subtotal. • Methods: We have used a model eye chamber to study the surface interactions of perfluorodecalin (PFD) with silicone oil and air to evaluate possible mechanisms of slippage. • Results: The results demonstrate that it is possible during a PFD/air exchange to trap a wedge of aqueous which is displaced laterally and forced posteriorly during removal of the PFD, whereas during a PFD/silicone oil exchange the remaining aqueous is displaced laterally and upwards and thus trapped above the silicone oil/PFD interface. • Conclusions: We believe that during PFD/air exchange the displacement of the aqueous posteriorly can cause slippage and that this could be avoided by performing a direct PFD/silicone oil exchange. Received: 28 April 1997 Revised version received: 28 July 1997 Accepted: 31 July 1997