Evaluation of Vitreous Substitutes in Managing Complicated Vitreo-retinal Surgeries

Abstract

Background: Vitreous substitutes presently in use for intraoperative tamponade are perfluorocarbon liquids (PFCL) and for post operative tamponade are silicon oil (SO), sulphur hexafluoride (SF 6 ) and perfluorocarbon gas (PFC). Several factors are important for a thorough understanding of each of these vitreous substitutes. The absorption or necessity for removal, indications for use (including clinical studies and special surgical methods), additives and complications of use have to be considered. Methods: Three port standard pars plana vitrectomy was performed in 60 consecutive cases requiring intra-vitreal intervention. PFCL was used intra-operatively in 30 cases (PFCL group and X group). The eyes were implanted with SO (silicon oil subgroup), PFC (C 3 F 8 sub-group) and SF 6 (SF 6 sub-group) in twenty cases each. Apart from best corrected visual acuity (BCVA), the retinal status and the longevity of gas when used, changes and reaction in both the anterior and posterior segments were noted. Result: The difference of postoperative BCVA in the PFCL and non-PFCL groups was statistically significant with p < 0.001. In both the PFCL and non-PFCL groups the difference between preoperative and postoperative BCVA was statistically significant with p < 0.0001. All three vitreous substitutes studied are effective given the case where they had been utilised. Conclusion: PFCL is invaluable in the management of complicated retinal detachment (RD). Where a vitreous microsurgery is indicated, the visual outcome is good. SF 6 is useful for short-term tamponade. Silicon oil and C 3 F 8 are useful for longer tamponade. MJAFI 2010; 66 : 125-128

Advances in Polysaccharide- and Synthetic Polymer-Based Vitreous Substitutes

“…Vitreous substitutes with gases are used for pneumatic retinopexy and post-operative endotamponade. These include the use of air and expansile gases such as sulfur hexafluoride (SF 6 ), perfluoroethane (C 2 F 6 ), and perfluoropropane (C 3 F 8 ) [ 12 , 24 , 25 ].…”

“…SO is a polymerised liquid siloxane that is hydrophobic. SO polymers are the most used vitreous substitute as they have high surface tension and viscosity, are easy to remove, have low toxicity, and are transparent [ 7 , 25 , 49 ]. These properties make SO substitutes the ideal long-term vitreous replacement.…”

Perfluorocarbons in Research and Clinical Practice: A Narrative Review

“…Several clinical studies support the efficacy of PFC formulations for the intraoperative and postoperative management of vitroretinal surgery. 9,58…”

“…A vitreous substitute for complex vitreoretinal surgeries. 9 5. Contrast media for 19 F-magnetic resonance imaging and diagnostic ultrasound.…”

Vitreous substitutes: An overview of the properties, importance, and development

“…Some commercially available short-term vitreous substitutes, for example, air (takes 5 days to absorb), Octafluoropropane (C 3 F 8 ) (4 weeks to absorb), and Sulfur hexafluoride (SF 6 ) (2 weeks to absorb), are being used nowadays for fresh retinal reattachment without PVR. 9,10 In more complicated cases, surgeons use various types of silicone oils. But, the use of silicone oil and fluorinated gases, as clinical tamponades, are limited due to their toxicity and other complication.…”