Heavy Internal Tamponade for Cases with Complicated Retinal Detachment

Zusammenfassung

Hintergrund: Es war Ziel dieser Analyse klinische Daten zur Effektivität und zu Komplikationen der Verwendung schwerer Endotamponaden (F6H8®, Oxane HD®, Densiron 68®) bei komplizierten Netzhautablösungen zu vergleichen. Methoden: Analysiert wurden alle in Medline gelisteten Arbeiten mit mindestens 10 behandelten Augen und eigene Resultate aus vier institutionellen Fallserien. Ergebnisse: Die Verwendung jeder der drei Endotamponademedien resultierte zu einem hohen Prozentsatz in einer erfolgreichen Netzhautanlage. Das Nebenwirkungsspektrum wies im Studienvergleich eine beträchtliche Variationsbreite auf. F6H8® führte in einem relativ hohen Prozentsatz zur Emulsifikation und war im Langzeitverlauf mit einem hohen Risiko der Entwicklung chronischer Hypotonien verbunden. Mit Oxane HD® endotamponierte Augen entwickelten relativ häufig eine klinisch signifikante entzündliche Reaktionen und sekundäre Membranen. Bei Densiron 68® kam es häufig zur Emulsifikation. Schlussfolgerungen: Die Heterogenität der vorhandenen Studien erlaubt keinen definitiven Vergleich der Endtamponademedien. Das verfügbare Datenmaterial lässt anscheinend Vorteile von Densiron 68® gegenüber den anderen schweren Endotamponaden hinsichtlich gravierender Nebenwirkungen erkennen. Vor dem Hintergrund relativ hoher Komplikationsraten schwerer Endotamponaden erscheint es ratsam, konventionelles „leichtes” Silikon als Mittel der ersten Wahl zu betrachten, sofern eine Silikonendotampanode angezeigt und ein Gravitationseffekt in den unteren Quadranten nicht erforderlich ist.

Abstract

Purpose: The aim of this review was to compare clinical data on the efficacy and complications of heavier-than-water internal tamponades (F6 H8®, Oxane HD®, Densiron 68®) used in eyes with complicated retinal detachments. Methods: An analysis was made of all case series with at least 10 eyes treated and cited in Medline together with results of 4 own institutional case series. Results: Short-term internal tamponade with each of the mentioned substances led to successful anatomic results in a relatively high percentage of eyes. The spectrum of complications presented a considerable variation among studies. Data indicate the following trends: F 6 H8® was reported to develop emulsification in a relatively high percentage of treated cases and was reported to be related with a high risk of long-term chronic hypotony. Eyes with Oxane HD® presented a relatively high rate of clinically significant inflammatory reactions and secondary membrane formation. Use of Densiron 68® was relatively frequently associated with emulsification. Conclusion: The heterogeneity of available clinical data does not allow a definitive comparison of the 3 heavier-than-water endotampondes. The data so far available seem to indicate as a trend that Densiron 68 may provide advantages compared to other substances concerning the relative incidence of severe complications. On the background of relatively high rates of heavy silicone complications it seems reasonable to regard conventional ”light” silicones as first choice if a silicone endotamponade is desired and no need for a gravity effect of the endotamponade is indicated.

schwere Endotamponade - Endotamponade - schweres Silikon - Densiron - Oxane HD - F6 H8 - Perfluorhexyloctane - Netzhaut - Ablatio retinae - proliferative Vitreoretinopathie

heavy internal tamponade - endotamponade - heavy silicone - Densiron - Oxane HD - F6 H8 - perfluorohexyloctane - retina - retinal detachment - proliferative vitreoretinopathy

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1 Several case series were not cited in this review because it was obvious or very probable by data comparison that patients mentioned there were subject of otherwise published reports (double publication or even triple publication). This applies to the following publications: Schatz et al. 2001, Spektrum Augenheilk; Sandner et al. 2006 & 2007, Romano et al. 2008, Graefes Arch Clin Exp Ophthalmol; Li et al. 2010, Ophthalmologica; Stappler et al. 2009, Ophthalmologe.

2 The term ”emulsification” is used here according to the convention in ophthalmological literature. The authors are aware that this does not comply with the precise scientific definition. The same applies to the description of silicone as ”oil”.

3 Pagot-Mathis et al. (2006) not listed since treatment consisted of two different silicones and results were not conclusive with respect to these different preparations.