Skip to main content
SpringerLink
Log in

Aktueller Stellenwert von schweren Flüssigkeiten als intraoperative Hilfsmittel bei vitreoretinalen Eingriffen

Current importance of heavy fluids as intraoperative aids in vitreoretinal surgery

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Einer der wesentlichen Meilensteine in der Behandlung komplexer Netzhautablösungen war die Entwicklung von schweren Flüssigkeiten als intraoperative Hilfsmittel. Dabei sind seit der Erstbeschreibung besonders die flüssigen Perfluorkarbone und Hydrofluorkarbone zu erwähnen. Unabhängig von der prinzipiellen Eignung der Substanzen ist die Reinheit bei der Herstellung ein entscheidender Faktor, der über mögliche Nebenwirkungen entscheidet. Ebenso kann es beim direkten Austausch gegen Silikonöl zu Vermengungen mit nachteiligem Ergebnis kommen. Netzhautchirurgen sollten über die Eigenschaften der verwendeten Tamponaden informiert sein. Trotz aller Erwartungen konnten sich die schweren Flüssigkeiten gegenüber dem Silikonöl nicht als Langzeittamponade durchsetzen, weshalb ihre Domäne der kurzfristige intraoperative Einsatz ist.

Abstract

A major milestone in the treatment of complex retinal detachment was the development of heavy fluids as intraoperative short-term tamponades. Since the introduction liquid perfluorocarbons and hydrofluorocarbons are particularly noteworthy. Irrespective of the suitability of the substances in principle, the purity during the manufacturing process is a decisive factor that determines possible side effects. Also, the direct exchange with silicone oil can lead to mixing with disadvantageous results. Retinal surgeons should be informed about the properties of the tamponades used. Despite all expectations, the heavy liquids could not become established compared to silicone oil as a long-term tamponade, which is why their domain is the short-term intraoperative use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Abdel-Meguid A, Lappas A, Hartmann K et al (2003) One year follow up of macular translocation with 360 degree retinotomy in patients with age related macular degeneration. Br J Ophthalmol 87:615–621

    Article  CAS  Google Scholar 

  2. Aisenbrey S, Lafaut B, Szurman P et al (2002) Macular translocation with 360 degree retinotomy in the treatment if exudative macular degeneration. Functional and angiographic results. Ophthalmologe 99:164–170

    Article  CAS  Google Scholar 

  3. Chan YK, Cheng HC, Wu J et al (2018) A perfluorobutylpentane (F4H5)-based solution for the removal of residual emulsified silicone oil. Acta Ophthalmol 96:e38–e45

    Article  CAS  Google Scholar 

  4. Chang S (1987) Low viscosity liquid fluorochemicals in vitreous surgery. Am J Ophthalmol 103:38–43

    Article  CAS  Google Scholar 

  5. Chang S (1992) Perfluorocarbon liquids in vitreoretinal surgery. Int Ophthalmol Clin 32:153–163

    Article  CAS  Google Scholar 

  6. Chang S, Lincoff H, Zimmerman NJ, Fuchs W (1989) Giant retinal tears. Surgical techniques and results using perfluorocarbon liquids. Arch Ophthalmol 107:761–766

    Article  CAS  Google Scholar 

  7. Chang S, Ozmert E, Zimmerman NJ (1988) Intraoperative perfluorocarbon liquids in the management of proliferative vitreoretinopathy. Am J Ophthalmol 106:668–674

    Article  CAS  Google Scholar 

  8. Chang S, Sparrow JR, Iwamoto T et al (1991) Experimental studies of tolerance to intravitreal perfluoro-n-octane liquid. Retina (Philadelphia, Pa) 11:367–374

    Article  CAS  Google Scholar 

  9. Chang S, Zimmerman NJ, Iwamoto T et al (1987) Experimental vitreous replacement with perfluorotributylamine. Am J Ophthalmol 103:29–37

    Article  CAS  Google Scholar 

  10. Clark LC (1978) Perfluorodecalin as a red cell substitute. Prog Clin Biol Res 19:69–80

    PubMed  Google Scholar 

  11. Devin F, Jourdan T, Saracco JB, Lucciani A (1995) Experimental tolerance to perfluorodecalin used in prolonged intraocular tamponade. Ophthalmologica 209:306–314

    Article  CAS  Google Scholar 

  12. Dixon DD, Holland DG (1975) Fluorocarbons: properties and syntheses. Fed Proc 34:1444–1448

    CAS  PubMed  Google Scholar 

  13. Dresp JH, Menz D‑H (2007) The phenomenon of “sticky” silicone oil. Graefes Arch Clin Exp Ophthalmol 245:863–868

    Article  Google Scholar 

  14. Drury B, Bourke RD (2011) Short-term intraocular tamponade with perfluorocarbon heavy liquid. Br J Ophthalmol 95:694–698

    Article  Google Scholar 

  15. Eckardt C, Nicolai U (1993) Clinical and histologic findings after several weeks of intraocular tamponade with perfluorodecalin. Ophthalmologe 90:443–447

    CAS  PubMed  Google Scholar 

  16. Eckardt C, Nicolai U, Winter M, Knop E (1991) Experimental intraocular tolerance to liquid perfluorooctane and perfluoropolyether. Retina (Philadelphia, Pa) 11:375–384

    Article  CAS  Google Scholar 

  17. Haidt S, Clark L, Gindberg J (1982) Liquid perfluorcarbon replacement of the eye. Invest Ophthalmol Vis Sci 22:233

    Google Scholar 

  18. Hoerauf H (2003) Flüssige Hydrofluorkarbone als Endotamponade und intraoperative Hilfsmittel in der Glaskörperchirurgie – Experimentelle Befunde und klinische Auswertung – Habilitationsschrift. Lübeck

  19. Hoerauf H, Faude F, Menz D‑H et al (2002) Determination of the solubility of perfluorocarbon liquids in silicone oil in vitro and in vivo. Retina (Philadelphia, Pa) 22:163–168

    Article  Google Scholar 

  20. Hoerauf H, Kobuch K, Dresp J, Menz DH (2001) Combined use of partially fluorinated alkanes, perfluorocarbon liquids and silicone oil: an experimental study. Graefes Arch Clin Exp Ophthalmol 239:373–381

    Article  CAS  Google Scholar 

  21. Hoerauf H, Roider J, Kobuch K, Laqua H (2005) Perfluorohexylethan (O62) as ocular endotamponade in complex vitreoretinal surgery. Retina (Philadelphia, Pa) 25:479–488

    Article  Google Scholar 

  22. Kobuch K, Menz IH, Hoerauf H et al (2001) New substances for intraocular tamponades: perfluorocarbon liquids, hydrofluorocarbon liquids and hydrofluorocarbon-oligomers in vitreoretinal surgery. Graefes Arch Clin Exp Ophthalmol 239:635–642

    Article  CAS  Google Scholar 

  23. Langefeld S, Kirchhof B, Meinert H et al (1999) A new way of removing silicone oil from the surface of silicone intraocular lenses. Graefes Arch Clin Exp Ophthalmol 237:201–206

    Article  CAS  Google Scholar 

  24. Machemer R, Buettner H, Norton EW, Parel JM (1971) Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol 75:813–820

    CAS  Google Scholar 

  25. Mackiewicz J, Maaijwee K, Lüke C et al (2007) Effect of gravity in long-term vitreous tamponade: in vivo investigation using perfluorocarbon liquids and semi-fluorinated alkanes. Graefes Arch Clin Exp Ophthalmol 245:665–675

    Article  CAS  Google Scholar 

  26. Meinert H (1995) Perfluorchemikalien in der Augenheilkunde: Materialien und Grundvoraussetzungen. Akt Augenheilkd 20:239–248

    Google Scholar 

  27. Meinert H, Roy T (2000) Semifluorinated alkanes A new class of compounds with outstanding properties for use in ophthalmology. Eur J Ophthalmol 10:189–197

    Article  Google Scholar 

  28. Menz D‑H (1997) Fluorierte Alkane und ihre Verwendung. Patent DE19719280C1

  29. Menz D‑H, Feltgen N, Menz H et al (2018) How to ward off retinal toxicity of perfluorooctane and other perfluorocarbon liquids? Invest Ophthalmol Vis Sci 59:4841–4846

    Article  CAS  Google Scholar 

  30. Mikhail MA, Mangioris G, Best RM et al (2017) Management of giant retinal tears with vitrectomy and perfluorocarbon liquid postoperatively as a short-term tamponade. Eye (Lond) 31:1290–1295. https://doi.org/10.1038/eye.2017.157

    Article  CAS  Google Scholar 

  31. Miyamoto K, Refojo MF, Tolentino FI et al (1984) Perfluoroether liquid as a long-term vitreous substitute. An experimental study. Retina (Philadelphia, Pa) 4:264–268

    Article  CAS  Google Scholar 

  32. Nakamura K, Refojo MF, Crabtree DV (1990) Factors contributing to the emulsification of intraocular silicone and fluorosilicone oils. Invest Ophthalmol Vis Sci 31:647–656

    CAS  PubMed  Google Scholar 

  33. Neuhann I, Bartz-Schmidt K‑U (2013) Primary vitrectomy for rhegmatogenous retinal detachment without use of heavy liquids. Klin Monbl Augenheilkd 230:1025–1028. https://doi.org/10.1055/s-0032-1328620

    Article  CAS  PubMed  Google Scholar 

  34. Osterholz J, Winter M, Winkler J et al (2009) Retinal damage by perfluorocarbon liquids - a question of specific gravity? Intraocular pressure peaks and shearing forces. Klin Monbl Augenheilkd 226:38–47. https://doi.org/10.1055/s-2008-1027764

    Article  CAS  PubMed  Google Scholar 

  35. Pastor JC, Coco RM, Fernandez-Bueno I et al (2017) Acute retinal damage after using a toxic perfluoro-octane for vitreo-retinal surgery. Retina (Philadelphia, Pa) 37:1140–1151. https://doi.org/10.1097/IAE.0000000000001680

    Article  CAS  Google Scholar 

  36. van der Puy M, Persichini P, Poss A et al Method of dissolving contaminants from substrates by using hydrofluorocarbon solvents having a portion which is fluorocarbon and the remaining portion is hydrocarbon. https://patentimages.storage.googleapis.com/19/1c/f4/5b415b07651389/US5275669.pdf

  37. Rizzo S, Belting C, Genovesi-Ebert F, Hagedorn N (2012) Colored perfluorocarbon liquids as novel intraoperative tools. Graefes Arch Clin Exp Ophthalmol 250:653–659. https://doi.org/10.1007/s00417-011-1874-7

    Article  CAS  PubMed  Google Scholar 

  38. Roider J, Hoerauf H, Kobuch K, Gabel V‑P (2002) Clinical findings on the use of long-term heavy tamponades (semifluorinated alkanes and their oligomers) in complicated retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 240:965–971. https://doi.org/10.1007/s00417-002-0574-8

    Article  CAS  Google Scholar 

  39. Shaikh S, Trese MT (2002) Retinal reattachment facilitated by short-term perfluorocarbon liquid tamponade in a case of fevr and rhegmatogenous retinal detachment. Retina (Philadelphia, Pa) 22:674–676

    Article  Google Scholar 

  40. Sirimaharaj M, Balachandran C, Chan WC et al (2005) Vitrectomy with short term postoperative tamponade using perfluorocarbon liquid for giant retinal tears. Br J Ophthalmol 89:1176–1179

    Article  CAS  Google Scholar 

  41. Stalmans P, Pinxten A‑M, Wong DS (2015) Cohort safety and efficacy study of Siluron2000 emulsification-resistant silicone oil and F4h5 in the treatment of full-thickness macular hole. Retina (Philadelphia, Pa) 35:2558–2566

    Article  Google Scholar 

  42. Turberg M, Brady J (1988) Semifluorinated hydrocarbons: primitive surfactant molecules. J Am Chem Soc 110(23):7797–7801

    Article  CAS  Google Scholar 

  43. Velikay M, Stolba U, Wedrich A et al (1995) The effect of chemical stability and purification of perfluorocarbon liquids in experimental extended-term vitreous substitution. Graefes Arch Clin Exp Ophthalmol 233:26–30

    Article  CAS  Google Scholar 

Download references

Danksagung

Die Autoren bedanken sich bei Dr. Joachim Dresp für die Unterstützung, die Diskussionen und die hilfreichen Ratschläge.

Author information

Authors and Affiliations

  1. Augenklinik, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    Nicolas Feltgen & Hans Hoerauf

Authors
  1. Nicolas Feltgen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans Hoerauf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicolas Feltgen.

Ethics declarations

Interessenkonflikt

N. Feltgen und H. Hoerauf geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feltgen, N., Hoerauf, H. Aktueller Stellenwert von schweren Flüssigkeiten als intraoperative Hilfsmittel bei vitreoretinalen Eingriffen. Ophthalmologe 116, 919–924 (2019). https://doi.org/10.1007/s00347-019-0935-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-019-0935-x

Schlüsselwörter

Keywords

Search

Navigation