Pneumatic retinopexy by evaporation of fluorocarbon liquids: in vitro and in vivo results.

PURPOSE: To develop an expanding gas tamponade allowing a controlled and complete filling of the vitreous cavity in the non-vitrectomized eye. METHODS: Twenty-two different liquid fluorocarbon mixtures with a high vapour pressure were tested in an in vitro eye model and in rabbit eyes. The intraocular pressure (IOP), the anterior segment of the eye, the vitreous and the retina were inspected at each examination during a period of 2 weeks. The timepoint of maximal gas expansion and the period required for complete absorption of the gas bubble were recorded. RESULTS: In vitro, admixtures of perfluorocarbons (PFCLs) and of semifluorinated alkanes (SFAs) with ether/alkanes generated limited temporary gas expansion but increased IOP. Admixtures of n-pentane in paraffin oil or silicone oil resulted in incomplete gas filling remaining for several days, with moderate IOP. In vivo, different clinical features and gas expansion were observed after the injection of PFCLs saturated with CO(2) or SF(6). Normal IOP was noted, but only with a transient and incomplete gas expansion and tamponade. For example, with n-pentane/n-hexane/perfluoromethylcyclopentane/perfluoromethyl-cyclohexane (1:1:1:1) a very rapid gas expansion was observed, followed by a raised IOP, a shallow anterior chamber, and finally rupture of the globe. The correlation between the in vitro and in vivo data was low. CONCLUSIONS: Gas endotamponade based on evaporation of liquid fluorocarbons is possible, but a complete and reliable tamponade could not be achieved. The best results were demonstrated by admixtures with an overall density <1.00 g/cm(3), an inert carrier with high vapour pressure, and a highly volatile substance. Further detailed investigation into the factors influencing evaporation is required.

In vivo retinal tolerance of various heavy silicone oils.

PURPOSE: Heavy silicone oils are currently under investigation as a permanent tamponade in eyes with inferior PVR. This study was an investigation of Densiron 68 (Fluoron GmbH, Neu-Ulm, Germany) and several new heavy silicone oil admixtures on the basis of the perfluoroalkanes F4H5 (perfluorobutylpentane), F4H6 (perfluorobutylhexane), and F4H8 (perfluorobutyloctane) with respect to their long-term tolerance in a rabbit model. METHODS: Because of the better solubility of the F4Hn-species (n = 5-8) in comparison to F6H8, we used F4H5, F4H6, and F4H8 to generate highly viscous, heavy silicone oils (HSO). After vitrectomy and fluid-air exchange, the left eye of each of five rabbits per group was filled with HSO 68-1500 (Densiron 68), HSO 45-5000, HSO 45-3000, HSO 46-5000, HSO 46-3000, HSO 48-5000, or HSO 48-3000, or pure F4H5, F4H6, or F4H8. Detailed clinical investigation, ERG testing, and histologic evaluation were performed throughout a 3-month follow-up. RESULTS: Densiron 68 and HSOs based on F4H5, as well as the three control oils (silicone oil of 1000, 3000, and 5000 mPa . s) were well tolerated over 3 months. Histologically, the retina was unaffected. In contrast, intraocular inflammation, cataract formation, and retinal detachment and degeneration were noticed in all groups with HSOs based on F4H6 or F4H8. CONCLUSIONS: Biocompatibility of the new HSOs is dependent on the lipophilic behavior (R(F)/R(H) ratio) and furthermore on the molecular dimension of the used semifluorinated alkanes (SFAs). HSOs on the basis of F4H5 may have advantages over silicone oils, on the basis of F6H8, for use as a tamponade agent for the inferior retina in difficult retinal situations.

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/cm(3)), F6H8 (pure) (1.33 g/cm(3)), or a 1:1 mixture of F6H8/PFD (1.62 g/cm(3)). 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.