Perfluorocarbon syndrome—a possible, overlooked source of fatal gas embolism following uveal-melanoma endoresection

Rüschen, Heinrich; Romano, Mario R.; Ferrara, Mariantonia; Loh, Graeme K.; Wickham, Louisa; Damato, Bertil; Cruz, Lyndon da

doi:10.1038/s41433-022-02021-6

“…It is known that air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion [57,58]. Ruschen et al hypothesized that a gas embolism was due to the entry of perfluorooctane into the bloodstream with the formation of gas bubbles in the pulmonary circulation, and the association with an increased vapor pressure of perfluorooctane [57]. In our case we always used perfluorodecalin, which has been reported to enter circulation during endoresection without systemic complications [58].…”

Section: Discussionmentioning

confidence: 74%

“…Previously, air was used to flatten the retina in this surgical procedure; however, this method was abandoned after the report of intraoperative and early postoperative death caused by air embolism [55,56]. It is known that air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion [57,58]. Ruschen et al hypothesized that a gas embolism was due to the entry of perfluorooctane into the bloodstream with the formation of gas bubbles in the pulmonary circulation, and the association with an increased vapor pressure of perfluorooctane [57].…”

Section: Discussionmentioning

confidence: 99%

Anatomical and Functional Outcomes after Endoresection and Adjuvant Ruthenium Brachytherapy for Uveal Melanoma: A Single-Center Experience

Mazzini

¹

,

Vicini

²

,

Leo

³

et al. 2023

Life

2

0

1

View full text Add to dashboard Cite

Purpose: To evaluate the anatomical and functional outcomes of endoresection and adjuvant ruthenium (Ru)-106 brachytherapy for uveal melanoma (UM). Methods: Retrospective case series of 15 UM patients (15 eyes) treated at our center (Careggi University Hospital, Florence). Results: Six patients (40%) were male and nine were female (60%). The mean age of patients at the time of treatment was 61.6 years (±19.41). The mean BCVA at baseline was 20/50. In all cases UM originated from the choroid. The mean tumor thickness at baseline was 7.14 mm (±2.05), and the mean largest basal diameter was 11.2 mm (±1.92). A concurrent retinal detachment was diagnosed in 11 patients (73.3%). Two patients (13.3%) showed vitreous seeding at baseline. Eleven patients (73.3%) were treated with primary endoresection, while four patients (26.7%) were treated with a “salvage endoresection” after primary treatment failure (previous radiation treatment). The mean follow-up time was 28.9 months (±10.6). Thirteen out of fifteen patients were alive and showed no evidence of local recurrence or distance metastasis at the last follow-up visit. The treatment achieved local control of the disease in 14 out of 15 cases (93.3%). In one case, the patient underwent enucleation for disease recurrence. The overall survival rate at the end of the follow-up was 93.3%. The mean BCVA at last follow-up visit was 20/40. Treatment was well tolerated, without significant complications. Conclusions: Endoresection and adjuvant Ru-106 brachytherapy is a valuable conservative option for selected UM patients and can be used both as a primary treatment and as a salvage therapy. It can control melanoma and avoid enucleation, reduce radiation-related complications, and provide tumor tissue for chromosomal analysis and prognostic testing.

show abstract

“…It is known that air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion [57,58]. Ruschen et al hypothesized that a gas embolism was due to the entry of per uorooctane into the bloodstream with the formation of gas bubbles in the pulmonary circulation, and the association with an increased vapor pressure of per uorooctane [57]. In our case we always used per uorodecalin, which has been reported to enter circulation during endoresection without systemic complications [58].…”

Section: Discussionmentioning

confidence: 86%

Anatomical and Functional Outcomes after Endoresection and Adjuvant Ruthenium Brachytherapy for Uveal Melanoma: A Single-Center Experience

Mazzini

¹

,

Vicini

²

,

Leo

³

et al. 2023

Preprint

0

View full text Add to dashboard Cite

Purpose: To evaluate the anatomical and functional outcomes of endoresection and adjuvant ruthenium (Ru)-106 brachytherapy for uveal melanoma (UM). Methods: Retrospective case series of 15 UM patients (15 eyes) treated at our center (Careggi University Hospital, Florence). Results: Six patients (40%) were male and nine were female (60%). The mean age of patients at the time of treatment was 61.6 years (±19.41). The mean BCVA at baseline was 20/50. In all cases UM originated from the choroid. The mean tumor thickness at baseline was 7.14 mm (±2.05), and the mean largest basal diameter was 11.2 mm (±1.92). A concurrent retinal detachment was diagnosed in 11 patients (73.3%). Two patients (13.3%) showed vitreous seeding at baseline. Eleven patients (73.3%) were treated with primary endoresection, while four patients (26.7%) were treated with a “salvage endoresection” after primary treatment failure (previous radiation treatment). The mean follow-up time was 28.9 months (±10.6). Thirteen out of fifteen patients were alive and showed no evidence of local recurrence or distance metastasis at the last follow-up visit. The treatment achieved local control of the disease in 14 out of 15 cases (93.3%). In one case, the patient underwent enucleation for disease recurrence. The overall survival rate at the end of the follow-up was 93.3%. The mean BCVA at last follow-up visit was 20/40. Treatment was well tolerated, without significant complications. Conclusions: Endoresection and adjuvant Ru-106 brachytherapy is a valuable conservative option for selected UM patients and can be used both as a primary treatment and as a salvage therapy. It can control melanoma and avoid enucleation, reduce radiation-related complications, and provide tumor tissue for chromosomal analysis and prognostic testing.

show abstract

“…Previously, air was used to atten the retina in this surgical procedure, however, this method was abandoned after the report of intraoperative and early postoperative death caused by air embolism 41,42 . It is known that air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion 54,55 . Ruschen et al hypothesized that a gas embolism was due to the entry of per uorooctane into the bloodstream with the formation of gas bubbles in the pulmonary circulation, and the association with an increased vapor pressure of per uorooctane 54 .…”

Section: Discussionmentioning

confidence: 99%

“…It is known that air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion 54,55 . Ruschen et al hypothesized that a gas embolism was due to the entry of per uorooctane into the bloodstream with the formation of gas bubbles in the pulmonary circulation, and the association with an increased vapor pressure of per uorooctane 54 . In our case we always used per uorodecalin, which has been reported to enter circulation during endoresection without systemic complication 55 .…”

Section: Discussionmentioning

confidence: 99%

Anatomical and functional outcomes after endoresection and adjuvant ruthenium brachytherapy for uveal melanoma: a single center case series

Mazzini

¹

,

Vicini

²

,

Pieretti

³

et al. 2022

Preprint

0

View full text Add to dashboard Cite

Purpose: To evaluate the anatomical and functional outcomes after endoresection and adjuvant Ruthenium(Ru)-106 brachytherapy for uveal melanoma (UM). Methods: Retrospective case series of 15 UM patients (15 eyes) treated at our centre (Careggi University Hospital, Florence). Results: Six patients (40%) were male and 9 females (60%). The mean age of patients at the time of treatment was 61.6 years (±19.41). The mean BCVA at baseline was 20/50. In all cases UM originated from the choroid. The mean tumor thickness at baseline was 7.14 mm (± 2.05), and the mean largest basal diameter was 11.2 mm (± 1.92). A concurrent retinal detachment was diagnosed in 11 patients (73.3%). Two patients (13.3%) showed vitreous seeding at baseline. Eleven patients (73.3%) were treated with primary endoresection, while 4 patients (26.7%) were treated with a “salvage endoresection” after primary treatment failure (previous radiation treatment). The mean follow-up time was 28.9 months (± 10.6). Thirteen out of 15 patients were alive and with no evidence of local recurrence or distance metastasis at the last follow-up visit. The treatment achieved local control of the disease in 14 out of 15 cases (93.3%). In one case patient underwent enucleation for disease recurrence. The overall-survival rate at the end of the follow-up was 93.3%. The mean BCVA at last follow-up visit was 20/40. Treatment was well tolerated, without significant complications. Conclusions: Endoresection is a valuable conservative option for selected UM patients and can be used both as a primary treatment and as a salvage therapy. It allows to control melanoma and avoid enucleation, reduces the radiation-related complications, and provides tumor tissue for chromosomal analysis and prognostic testing.

show abstract

Perfluorocarbon syndrome—a possible, overlooked source of fatal gas embolism following uveal-melanoma endoresection

Cited by 7 publications

References 7 publications

Anatomical and Functional Outcomes after Endoresection and Adjuvant Ruthenium Brachytherapy for Uveal Melanoma: A Single-Center Experience

Anatomical and Functional Outcomes after Endoresection and Adjuvant Ruthenium Brachytherapy for Uveal Melanoma: A Single-Center Experience

Anatomical and Functional Outcomes after Endoresection and Adjuvant Ruthenium Brachytherapy for Uveal Melanoma: A Single-Center Experience

Anatomical and functional outcomes after endoresection and adjuvant ruthenium brachytherapy for uveal melanoma: a single center case series

Contact Info

Product

Resources

About