Intraoperative Use of Perfluo rocarbon Liquids in the Management of Proliferative Vitreoretinopathy

Perfluorocarbon liquids have been shown to be a useful intraoperative adjunct in managing complicated retinal detachment. To prove the effectiveness of intraoperative use of perfluorocarbon liquid and the improvement of surgical and functional outcomes, we retrospcetively evaluated the clinical results of the patients[13 eyes]who had retinal detachment complicated with proliferative vitreoretinopathy [over PVR Grade C4, C4 :7 eyes, C5 :6 eyes]. We performed standard 3-port pars plana vitrectomy in all eyes included in this study.Perfluorodecalin[DK-line]was used as a shortterm vitreous substitute intraoperatively and removed before the end of the surgery. The mean follow-up period was 15 months.Anatomical success rate was 86%[6 eyes]in Grade C4, 67%[4 eyes]in Grade C5, Visual acuity was over 5/200 in one eye[8%]and there was improvement in 5 eyes[40%] although it was below 5/200. Consequently, we could easily manage the retinal detachment with PVR with help of intraoperative perfluorocarbon liquid and could improve the postoperative surgical and visual outcomes.

Experimental Studies on the Retinal Responses to Intravitreal Perfluorocabon Liquids

Perfluorocarbon liquids (PFCLs) are useful tools during vitreous surgery for complicated retinal detachments. Generally, these liquids are used as short-term vitreous replacement without retinal toxicities. But long-term tolerance of intraocular fluorochemicals is not established. We evaluated long-term tolerances to intraocular perfluorophenanthrene(Vitreon) or perfluorodecalin(DK-line) in the rabbit retina for a period of up to 3 months. Three days after C3F8 gas-compression of the vitreous, 1.2ml of highly purified PFCLs were injected into 26 rabbit eyes. Control eyes received same volumes of balanced salt solution. Eyes were examined by indirect ophthalmoscopy and light and electron microscopy. Clinically PFCLs were emulsified and dispersed into small bubbles after 2-3 weeks. Mild posterior subcapsular cataracts and vitreous opacities were observed after long-term retention of PFCLs. Histopathologically, at 1 week after surgery, several epiretinal macrophages were present in both groups. Focal disarrangements of photoreceptors were observed in perfluorodecalintreated group. At I month after surgery, protrusion of Muller cell, dropdown of photoreceptor nuclei, loss of photoreceptors, outer and inner segments and retinal pigment epithelial hypertrophy were observed. In perfluorodecalin-treated group, atrophy in outer nuclear layer and thinning of all the retinal layers occurred. At 3 months after surgery, small oil-like droplets were scattered throughout the retinal layers and retinal pigment epithelium in perfluorodecalin-treated group. These findings were almost totally confined to the lower part of retina that has been long-term contact with the liquids. Our findings suggest that perfluorodecalin is more toxic to the retina than perfluorophenanthrene. Both liquids are not adequate for long-term vitreous replacement, but may be useful for short-term intraoperative use.

A Study on The Corneal Toxicity of Perfluorocarbon Liquid in The Rabbit Eye

Perfluorocarbon liquids(PFCL) have been used as an intraoperative tool for repair of complicated retinal detachment with improving surgical results. However, little is known about the potential toxic effect of PFCL that remain in the eye after surgery to anterior segment tissue. In this study we evaluated the effect of this substance on the corneal tissue. Eight rabbits underwent injection of 50 micro l of perfluorodecalin in the anterior chamber of the right eyes. The left eyes were injected with the same amount of balanced salt solution(BSS) as a control. The clinical appearance of the eyes were recorded at three days, one week and two weeks after injection, and histological examination was done two weeks after injection. The differences of intraocular pressure(IOP) between the right and left eyes were not statistically significant at three days, one week and two weeks after injection, and all of right eyes showed inferior bulbar counctival injection for same periods. In the histological examination of cornea exposed to PFCL, the number and the height of endothelial cells were reduced and decreased, respectively. These findings suggested that PFCL may have a toxic effect on the corneal endothelial cells.

Treatment of Complicated Retinal Detachments by Intraoperative Use of Perfluorphenantenanthrene Liquid

We have applied the intraoperative use of Perfluorophenanthrene (C14F24) liquid in 19 eyes of complicated retinal detachment surgery in 19 patients since November 1990 to October 1991. The vast majority of case of retinal detachment was trauma (9 eyes) and uveitis including pars planitis (6 eyes) remainders were juvenile retinoschisis, cataract surgery, myopIa, diabetes one eye each. The grade-D of proliferative change was found in 9 eyes (D1 3 eyes, D2 3 eyes, D3 3 eyes) and 8 eyes belong to over grade-C2 (C2 4 eyes, C3 4 eyes). Multiple anterior retinal tears were found in two. Giant retinal tear was noticed in 5 eyes and the other one was made on therapeutic purpose. Intraoperative reattachment was obtained in all eyes. The follow-up periods were 6 or more (mean 9.1) months. At last follow-up, the retina was attached in 12 eyes (63%), partially attached in 2 (10%) and redetached in 5 (26%). Visual acuity was improved or same in 12 eyes (63%), became worse in 7(37%). Visual acuity of 0.02 or better was obtained in 12(63%) eyes and 3(16%) saw 0.1 or better. Perfluorophenanthrene liquid was thought as non-toxic, heavy biomaterial and effective to treat the complicated retinal detachments.