Heavy Internal Tamponade for Cases with Complicated Retinal Detachment

Zusammenfassung

Hintergrund: Es war Ziel dieser Analyse klinische Daten zur Effektivität und zu Komplikationen der Verwendung schwerer Endotamponaden (F6H8®, Oxane HD®, Densiron 68®) bei komplizierten Netzhautablösungen zu vergleichen. Methoden: Analysiert wurden alle in Medline gelisteten Arbeiten mit mindestens 10 behandelten Augen und eigene Resultate aus vier institutionellen Fallserien. Ergebnisse: Die Verwendung jeder der drei Endotamponademedien resultierte zu einem hohen Prozentsatz in einer erfolgreichen Netzhautanlage. Das Nebenwirkungsspektrum wies im Studienvergleich eine beträchtliche Variationsbreite auf. F6H8® führte in einem relativ hohen Prozentsatz zur Emulsifikation und war im Langzeitverlauf mit einem hohen Risiko der Entwicklung chronischer Hypotonien verbunden. Mit Oxane HD® endotamponierte Augen entwickelten relativ häufig eine klinisch signifikante entzündliche Reaktionen und sekundäre Membranen. Bei Densiron 68® kam es häufig zur Emulsifikation. Schlussfolgerungen: Die Heterogenität der vorhandenen Studien erlaubt keinen definitiven Vergleich der Endtamponademedien. Das verfügbare Datenmaterial lässt anscheinend Vorteile von Densiron 68® gegenüber den anderen schweren Endotamponaden hinsichtlich gravierender Nebenwirkungen erkennen. Vor dem Hintergrund relativ hoher Komplikationsraten schwerer Endotamponaden erscheint es ratsam, konventionelles „leichtes” Silikon als Mittel der ersten Wahl zu betrachten, sofern eine Silikonendotampanode angezeigt und ein Gravitationseffekt in den unteren Quadranten nicht erforderlich ist.

Abstract

Purpose: The aim of this review was to compare clinical data on the efficacy and complications of heavier-than-water internal tamponades (F6 H8®, Oxane HD®, Densiron 68®) used in eyes with complicated retinal detachments. Methods: An analysis was made of all case series with at least 10 eyes treated and cited in Medline together with results of 4 own institutional case series. Results: Short-term internal tamponade with each of the mentioned substances led to successful anatomic results in a relatively high percentage of eyes. The spectrum of complications presented a considerable variation among studies. Data indicate the following trends: F 6 H8® was reported to develop emulsification in a relatively high percentage of treated cases and was reported to be related with a high risk of long-term chronic hypotony. Eyes with Oxane HD® presented a relatively high rate of clinically significant inflammatory reactions and secondary membrane formation. Use of Densiron 68® was relatively frequently associated with emulsification. Conclusion: The heterogeneity of available clinical data does not allow a definitive comparison of the 3 heavier-than-water endotampondes. The data so far available seem to indicate as a trend that Densiron 68 may provide advantages compared to other substances concerning the relative incidence of severe complications. On the background of relatively high rates of heavy silicone complications it seems reasonable to regard conventional ”light” silicones as first choice if a silicone endotamponade is desired and no need for a gravity effect of the endotamponade is indicated.

Schlüsselwörter

schwere Endotamponade - Endotamponade - schweres Silikon - Densiron - Oxane HD - F6 H8 - Perfluorhexyloctane - Netzhaut - Ablatio retinae - proliferative Vitreoretinopathie

Key words

heavy internal tamponade - endotamponade - heavy silicone - Densiron - Oxane HD - F6 H8 - perfluorohexyloctane - retina - retinal detachment - proliferative vitreoretinopathy

References

• 1 Ang G S, Murphy A L, Ng W S et al. Oxane HD and retinal detachment surgery in routine clinical practice.  Ophthalmologica. 2010;  224 347-353
• 2 Auriol S, Pagot-Mathis V, Mahieu L et al. Efficacy and safety of heavy oil Densiron 68® in the treatment of complicated retinal detachment with large inferior retinectomy.  Graefes Arch Clin Exp Ophthalmol. 2008;  246 1383-1389
• 3 Azen S P, Scott I U, Flynn H W et al. Silicone oil in the repair of complex retinal detachments. A prospective observational multicenter study.  Ophthalmology. 1998;  105 1589-1597
• 4 Boscia F, Furino C, Recchimurzo N et al. Oxane HD vs silicone oil and scleral buckle in retinal detachment with proliferative vitreoretinopathy and inferior retinal breaks.  Graefes Arch Clin Exp Ophthalmol. 2008;  246 943-948
• 5 Berker N, Batman C, Ozdamar Y et al. Long-term outcomes of heavy silicone oil tamponade for complicated retinal detachment.  Eur J Ophthalmol. 2007;  17 797-803
• 6 Er H. Primary heavy silicone oil usage in inferior rhegmatogenous retinal detachment.  Ophthalmologica. 2010;  224 122-125
• 7 Federman J L, Schubert H D. Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery.  Ophthalmology. 1988;  95 870-876
• 8 Gerding H, Kolck A. Perfluorhexyloktan (F6 H8) als Endotamponade bei Patienten mit komplizierter Netzhautablösung.  Ophthalmologe. 2004;  101 255-262
• 9 Gerding H, Stupp N. Results after Oxane HD internal tamponade in patients with complicated retinal detachment. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. 2004 , Abstractband p 267
• 10 Gerding H, Stupp N. Clinical results after Densiron heavy internal tamponade in eyes with complicated retinal detachment. 2005 , ARVO Abstract 2005, #5506 http://www.arvo.org
• 11 Gerding H, Loukopoulos V, Riese J et al. Clinical results of pars plana-vitrectomy with Densiron 68 heavy internal tamponade used for primary retinal detachment surgery in eyes with complicated rhegmatogenous retinal detachment and clinically significant PVR. ARVO Abstract 2009, #3172 http://www.arvo.org
• 12 Heimann H, Bartz-Schmidt K U, Bornfeld N et al. Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study.  Ophthalmology. 2007;  114 2142-2154
• 13 Herbrig E, Sandner D, Engelmann K. Anatomical and functional results of endotamponade with heavy silicone oil – Densiron® 68 in complicated retinal detachment.  Ophthalmic Res. 2007;  39 198-206
• 14 Joussen A M, Kirchhof B, Schrage N et al. Heavy silicone oil versus standard silicone oil as vitreous tamponade in inverior PVR (HSO Study): design issues and implications.  Acta Ophthalmol Scand. 2007;  85 623-630
• 15 Kirchhof B, Wong D, Meurs van J et al. Use of perfluorohexyloctane as a long-term internal tamponade agent in complicated retinal detachment surgery.  Am J Ophthalmol. 2002;  133 95-101
• 16 Li W, Zheng J, Zheng Q et al. Clinical complications of Densiron 68 intraocular tamponade for complicated retinal detachment.  Eye. 2010;  24 21-28
• 17 Lim B L, Fransco B V. Densiron intraocular tamponade: a case series.  Clin Exp Ophthalmol. 2008;  36 261-264
• 18 Lucke K, Laqua H. Silicone oil in the treatment of complicated retinal detachment. Berlin: Springer; 1990
• 19 Meng Q, Shaochong Z, Cheng H et al. Long-term outcomes of Oxane HD as intraocular tamponade in the treatment of complicated retinal detachment.  Graefes Arch Clin Exp Ophthalmol. 2010;  248 1091-1096
• 20 Rizzo S, Genovesi-Ebert F, Belting C et al. A pilot study on the use of silicone oil-RMN3 mixture as heavier-than-water endotampoande agent.  Graefes Arch Clin Exp Ophthalmol. 2005;  28 1-5
• 21 Sandner D, Engelmann K. First experiences with high-density silicone oil (Densiron) as an intraocular tamponade in complex retinal detachment.  Graefes Arch Clin Exp Ophthalmol. 2006;  244 609-619
• 22 Sandner D, Herbrig E, Engelmann K. High-density silicone oil (Densiron) as a primary tamponade: 12-month follow-up.  Graefes Arch Clin Exp Ophtahlmol. 2007;  245 1097-1105
• 23 Schatz H, El-Shabrawi Y, Haas A et al. Adverse side effects with perfluorohexyloctane as a long-term tamponade agent in complicated vitreoretinal surgery.  Retina. 2004;  24 567-573
• 24 Stappler T, Heimann H, Wong D et al. Heavy tamponade 2 Densiron 68® in routine clinical practice: anatomical and functional outcomes of a consecutive case series.  Eye. 2008;  22 1360-1365
• 25 Stefaniotou M I, Aspiotis M V, Kitsos G D et al. Our experience with perfluorohexyloctane (F6 H8) as a temporary endotamponade in vitreoretinal surgery.  Eur J Ophthalmol. 2002;  12 518-522
• 26 Stupp N, Herbst H, Gerding H. Clinical and immunehistochemical findings after heavy internal tamponade with Oxane HD. ARVO Abstract 2005 #5505 http://www.arvo.org
• 27 Theelen T, Tilanus M, Klevering B J. Intraocular inflammation following endotamponade with high-density silicone oil.  Graefes Arch Clin Exp Ophthalmol. 2004;  242 617-620
• 28 Thelen U, Amler S, Osada N et al. Success rates of retinal buckling surgery: Relationship to refractive error and lens status: results from a large German Case Series.  Ophthalmology. 2010;  117 785-790
• 29 Wickham L, Tranos P, Hiscott P et al. The use of silicone oil-RMN3 (Oxane HD) as heavier-than-water internal tamponade in complicated inferior retinal detachment surgery.  Graefes Arch Clin Exp Ophthalmol. Epub: 27 March 2010
• 30 Wolf S, Schon V, Meier P et al. Silicone oil–RMN3 mixture (‘heavy silicone oil’) as internal tamponade for complicated retinal detachment.  Retina. 2003;  23 335-342
• 31 Wong D, Van Meurs J C, Stappler T et al. A pilot study on the use of perfluorhexyloctane/silicone oil solution as a heavier-than-water internal tamponade agent.  Br J Ophthalmol. 2005;  89 662-665

1 Several case series were not cited in this review because it was obvious or very probable by data comparison that patients mentioned there were subject of otherwise published reports (double publication or even triple publication). This applies to the following publications: Schatz et al. 2001, Spektrum Augenheilk; Sandner et al. 2006 & 2007, Romano et al. 2008, Graefes Arch Clin Exp Ophthalmol; Li et al. 2010, Ophthalmologica; Stappler et al. 2009, Ophthalmologe.

2 The term ”emulsification” is used here according to the convention in ophthalmological literature. The authors are aware that this does not comply with the precise scientific definition. The same applies to the description of silicone as ”oil”.

3 Pagot-Mathis et al. (2006) not listed since treatment consisted of two different silicones and results were not conclusive with respect to these different preparations.