Abstract
Background
Conventional silicone oil provides suboptimal support of the inferior retina. In this study we evaluated the efficacy of Oxane HD in the management of complex retinal detachments involving lower quadrants of the retina.
Methods
A prospective, interventional, comparative study. Eighteen patients were recruited. Treatment outcomes were compared with a historical control group of 14 patients. Patients with grade C3 PVR or greater and inferior retinal breaks, recurrent inferior retinal detachments (with or without PVR) and giant retinal tears were included. In those patients who re-detached under heavy silicone oil (n = 4), retro-oil epiretinal membranes (ERMs) were obtained at the time of subsequent surgery to analyse the immunopathological response to oxane HD. Immunohistochemistry was used to detect glia, retinal pigment epithelium cells (RPE), macrophages, T lymphocytes, or neural elements in the tissue using well-characterised monoclonal antibodies.
Results
Retinal attachment of the posterior pole following removal of silicone oil was achieved in 66.6% of the treatment group (n = 12) and 64.3% of controls (n = 9) (p = 1.0). Post-operative PVR developed in five patients in the treatment group (27.8%) and five control patients (35.8%). Following removal of silicone oil, residual oil was observed in 27.8% of the treatment group and 7.1% of controls. Median visual acuity, 3 months following removal of silicone oil, was 2.0 (IQR 0.9–2.0) in the treatment group and 1.0 (IQR 0.6–1.8) in the control group. Complications in the treatment group included, hypotony (n = 3), uveitis (n = 2), glaucoma (n = 1). All ERMs analysed demonstrated microscopic appearances typical of PVR. The membranes were fibrocellular in nature, contained RPE and glial cells, and variable amounts of intracellular and extracellular pigment. In addition, all had a dense infiltrate of vacuolated (presumed oil-filled) macrophages.
Conclusion
We failed to observe an advantage following the use of Oxane HD in the treatment of inferior retinal detachments. Moreover, Oxane HD was difficult to remove and was associated with a higher incidence of complications.
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References
Azen SP, Scott IU, Flynn HW Jr, Lai MY, Topping TM, Benati L, Trask DK, Rogus LA (1998) Silicone oil in the repair of complex retinal detachments. A prospective observational multicenter study. Ophthalmology 105:1587–1597
Abrams GW, Azen SP, McCuen BW 2nd, Flynn HW Jr, Lai MY, Ryan SJ (1997) Vitrectomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy: results of additional and long-term follow-up. Silicone Study report 11. Arch Ophthalmol 115:335–344
Leaver P (1994) Complications of intraocular silicone oil. In: Ryan SJ, Glaser BM (eds) Retina: 2nd edition. Mosby, St Louis, pp 2165–2179
Wetterqvist C, Wong D, Williams R, Stappler T, Herbert E, Freeburn S (2004) Tamponade efficiency of perfluorohexyloctane and silicone oil solutions in a model eye chamber. Br J Ophthalmol 88:692–696
Fawcett I, Williams R, Wong D (1994) Contact angles of substances used for internal tamponade in retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 232:438–444
Han L, Cairns JD, Campbell WG, McCombe MF, Heriot WJ, Heinze JB (1998) Use of oil in the treatment of complicated retinal detachment: results from 1981 to 1994. Aust J Ophthalmol 26:299–304
Wolf S, Schon V, Meier P, Wiedemann P (2003) Silicone oil–RMN3 mixture (“heavy silicone oil”) as internal tamponade for complicated retinal detachment. Retina 23:335–342
Singh AK, Glaser BM, Lemor M, Michels RG (1986) Gravity-dependent distribution of retinal pigment epithelial cells dispersed into the vitreous cavity. Retina 6:77–80
Singh AK, Michels RG, Glaser BM (1986) Scleral indentation following cryotherapy and repeat cryotherapy enhance release of viable retinal pigment epithelial cells. Retina 6:176–178
Hiscott P, Magee RM, Colthurst M, Lois N, Wong D (2001) Clinicopathological correlation of epiretinal membranes and posterior lens opacification following perfluorohexyloctane tamponade. Br J Ophthalmol 85:179–183
Mertens S, Bednarz J, Engelmann K (2002) Evidence of toxic side effects of perfluorohexloctane after vitreoretinal surgery as well as in previously established in vitro models with ocular cell types. Graefes Arch Clin Exp Ophthalmol 240:989–995
Roider J, Hoerauf H, Kobuch K, Gabel VP (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
Schatz H, El-Shabrawi Y, Haas A, Langmann G (2004) Adverse side effects with perfluorohexyloctane as a long-term tamponade agent in complicated vitreoretinal surgery. Retina 24:567–573
Sandner DE, Engelmann K (2006) First experiences with high-density silicone oil (Densiron) as an intraocular tamponade in complex retinal detachment. Graefes Arch Clin Exp Ophthalmol 244:609–619
Gabel VP, Kampik A, Gabel CH, Spiegel D (1987) Silicone oil with high specific gravity for intraocular use. Br J Ophthalmol 71:262–267
Machemer R, Aaberg TM, Freeman HM, Irvine AF, Lean JS, Michels RM (1991) An updated classification of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol 112:159–165
Hiscott P (2001) Vitreous biopsy pathology: new kid on the block. Curr Diagnostic Pathol 7:45–55
Hiscott P, Gray R, Grierson I, Gregor Z (1994) Cytokeratin-containing cells in proliferative diabetic retinopathy membranes. Br J Ophthalmol 78:219–222
Asaria RH, Kon CH, Bunce C, Sethi CS, Limb GA, Khaw PT, Aylward GW, Charteris DG (2004) Silicone oil concentrates fibrogenic growth factors in the retro oil fluid. Br J Ophthalmol 88:1439–1442
Heimann H, Stappler T, Wong D (2008) Heavy tamponade 1: a review of indications, use, and complications. Eye 22:1342–1359
Theelen T, Tilanus MA, Klevering BJ (2004) Intraocular inflammation following endotamponade with high-density silicone oil. Graefes Arch Clin Exp Ophthalmol 242:617–620
Lewis H, Burke JM, Abrams GW, Aaberg TM (1988) Perisilicone proliferation after vitrectomy for proliferative vitreoretinopathy. Ophthalmology 95:583–591
Charteris DG, Hiscott P, Grierson I, Lightman S (1992) Proliferative vitreoretinopathy: lymphocytes in epiretinal membranes. Ophthalmology 99:1364–1367
Wickham LJ, Asaria RH, Alexander R, Luthert P, Charteris DG (2007) Immunopathology of intraocular silicone oil: retina and epiretinal membranes. Br J Ophthalmol 91:258–262
Kirchhof B, Tavakolian U, Paulmann H, Heimann K (1986) Histopathological findings in eyes after silicone oil injection. Graefes Arch Clin Exp Ophthalmol 224:34–37
Heidenkummer HP, Messmer EM, Kampik A (1996) Recurrent vitreoretinal membranes in intravitreal silicon oil tamponade. Morphologic and immunohistochemical studies. Ophthalmologe 93:121–125
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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 248, 1225–1231 (2010). https://doi.org/10.1007/s00417-010-1358-1
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DOI: https://doi.org/10.1007/s00417-010-1358-1