Efficacy of Short-term Postoperative Perfluoro-n-octane Tamponade for Pediatric Complex Retinal Detachment

doi:10.1016/j.ajo.2013.10.002

American Journal of Ophthalmology

Volume 157, Issue 2, February 2014, Pages 384-389.e2

https://doi.org/10.1016/j.ajo.2013.10.002 Get rights and content

Purpose

To evaluate the efficacy of perfluoro-n-octane as a postoperative short-term tamponade after vitrectomy in pediatric cases with complex retinal detachment (RD) and proliferative vitreoretinopathy (PVR).

Design

Prospective, noncomparative, interventional case series.

Methods

The medical records of 10 eyes of 9 children (6 boys and 3 girls), whose age ranged from 3 months to 11 years, with a median of 7.5 months, were reviewed. The cause of the PVR was retinopathy of prematurity (7 eyes of 6 patients); familial exudative vitreoretinopathy; or tractional RD associated with congenital optic nerve anomalies,¹ and persistent fetal vasculature. Perfluoro-n-octane was injected into the eyes at the primary surgery in 2 eyes and at the repeat surgeries in 8 eyes. The perfluoro-n-octane was removed after 1 to 4 postoperative weeks. The patients were followed for 5 to 43 months.

Results

At the last examination, the retinas were reattached in 8 eyes (80%). In the other two eyes, a retinal attachment was not obtained. Postoperatively, the best-corrected visual acuity improved from hand motion to 0.1 in 1 eye and could not be measured in the other 9 patients because of their ages. No apparent adverse events related to the use of perfluoro-n-octane were noted.

Conclusions

Although cautions should be exercised regarding potential mechanical retinal injuries by heavy liquids in the eye, short-term perfluoro-n-octane tamponade was effective in pediatric cases with severe PVR in which retinal reattachment is considered to be difficult with conventional gas or silicone oil tamponade.

Section snippets

Methods

The multicenter study was performed in accordance with the tenets of the Declaration of Helsinki. The Institutional Review Board of the Naha City Hospital and Sakai Hospital Kinki University Faculty of Medicine approved this prospective study before the beginning of the study, and a written informed consent was obtained from the parents of all patients. The protocol of this study was in compliance with Health Insurance Portability and Accountability Act requirements.

A perfluoro-n-octane

Case Report 1

Case 1 was an 8-year-old boy who was referred to us for the treatment of a rhegmatogenous RD involving the macula of the right eye. Fundus examinations revealed a retinal break in the inferior temporal retina of the right eye and a peripheral avascular area with fibrovascular membranes in the temporal retina in both eyes. These findings suggested that the patient had FEVR in both eyes. The decimal best-corrected visual acuity (BCVA) was 0.04 in the right eye. The retina was reattached by

Discussion

Postoperative perfluoro-n-octane tamponade was used for a short period in 10 eyes with pediatric complex RD, in which gas or silicone oil had been considered to be ineffective because the posterior proliferative changes were in the inferior retina. Perfluoro-n-octane tamponade was used because we believed that it would be difficult for children to maintain a prone position for any length of time. The perfluoro-n-octane was left in all of the eyes for 1 to 4 weeks, and the retinas remained

Ayako Imaizumi, MD, completed her residency in Ophthalmology at Osaka University Hospital. Currently she is the director of ophthalmology at Naha City Hospital and a postgraduate student at Graduate School of Medicine, University of the Ryukyus. Her field of interest includes surgical treatment of vitreoretinal disease such as diabetic retinopathy, retinal detachment, and retinopathy of prematurity.

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Recurrent proliferative vitreoretinopathy in a patient with morning glory syndrome and intellectual disability
2022, American Journal of Ophthalmology Case Reports
Citation Excerpt :
A third surgery was performed in which peripheral retinotomy and peeling of the proliferative membrane under perfluoro-n-octane (PFO) were followed by laser ablation on the peripheral retina to avoid the recurrent RD (Fig. 2B). PFO was retained to achieve better apposition of the retina and underlying RPE without maintaining face-down position.15 IOL was removed in the third surgery because of the severe PVR and fibrin formation on both anterior and posterior surfaces of the IOL.
To report a case of morning glory syndrome (MGS) with retinal detachment, in whom unusually severe proliferative vitreoretinopathy (PVR) developed after surgery.
A 6-year-old boy with intellectual disability underwent vitrectomy for retinal detachment associated with MGS in the left eye. Vitrectomy was performed five times. C₃F₈ gas tamponade was used for the first and second surgeries. However, the retina developed PVR with a nearly 360-degree giant retinal tear after the second surgery. The third surgery required 360-degree retinotomy, followed by short-term perfluoro-n-octane (PFO) tamponade, which was removed ten days later. During the fourth surgery, the retina was found to be flipped over in a funnel-shape on the retinal pigment epithelium under the PFO. Silicone oil (SO) tamponade was used. During the fifth surgery, the retina was flipped over under the SO again. We found that the patient shook his head rapidly and vigorously while crying.
We speculate that excessive head shaking associated with the patient's intellectual disability induced an unusual shape of the retina under PFO or SO. Although difficult to achieve, postoperative resting seems important in preventing such complications in intellectually disabled patients with retinal detachment.
Retinal detachment repair with perfluoro-N-octane endotamponade in an infant with juvenile X-linked retinoschisis
2020, American Journal of Ophthalmology Case Reports
Citation Excerpt :
Given that these changes occurred in the inferior retina, and similar histological changes occurred in the superior retina of rabbit eyes injected with silicone oil, it was postulated that these effects may be mechanical rather than toxic. In their series, Imaizumi and colleagues noted no adverse effects in eyes receiving PFO tamponade for periods between 1 and 5 weeks.6 The appropriate duration for retained PFO, therefore, seems to be 1–2 weeks.
We present a case of successful surgical management of an infant with X-linked retinoschisis with a giant retinal tear and retinal detachment of the right eye.
A 10-month-old male presented with retinoschisis of both eyes and a retinal detachment of the right eye. The patient underwent two-stage pars plana vitrectomy utilizing perfluoro-N-octane to stabilize the detached retina and facilitate posterior hyaloid separation. Retained perfluoro-N-octane tamponade was later exchanged with silicone oil. The retina remained attached at last follow up.
Retinal detachment repair in infants presents unique challenges. This is a safe and effective strategy for complex retinal detachment repair in the infant population.
Bilateral rhegmatogenous retinal detachments from giant retinal tears in an infant with abusive head trauma and Stickler syndrome
2020, American Journal of Ophthalmology Case Reports
Citation Excerpt :
The rate of anatomical success of retinal detachment surgery in pediatric cases is etiology-dependent with rhegmatogenous retinal detachments having better outcomes compared to tractional retinal detachments.11 The use of PFCL for short-term postoperative tamponade for retinal detachment in the pediatric population has previously been described in complex retinal detachment cases.13 PFCL was advantageous compared to silicone oil or gas tamponade in this infant as it allowed for supine positioning and eliminated the difficulty of prone positioning.
To present a rare presentation of abusive head trauma (AHT) in an infant with a hereditary vitreoretinopathy.
A two-month-old infant female victim of AHT presented with bilateral rhegmatogenous retinal detachments from giant retinal tears. She had rib fractures, a subdural hematoma, and hyphemas bilaterally. Retinal hemorrhages were not observed. The left eye was repaired by vitrectomy with intermediate-term perfluorocarbon liquid tamponade. Genetic testing demonstrated a pathogenic COL2A1 mutation confirming Stickler syndrome.
Ophthalmic complications of AHT classically manifest as retinal hemorrhages in multiple layers. Instead, bilateral RRDs from GRTs were observed in this infant with Stickler syndrome.
Autologous Retinal Transplant for Refractory Macular Holes: Multicenter International Collaborative Study Group
2019, Ophthalmology
Citation Excerpt :
We also did not observe any cases of PFC toxicity, elevated intraocular pressure, intraocular inflammation (early or delayed), or flap displacement after PFC removal. Short-term use of intraocular PFC has been shown to be relatively safe.43–47 We observed late development of cystoid macular edema–like changes in the graft in several cases, usually 4 to 6 months after surgery.
To report the structural and functional outcomes of autologous neurosensory retinal transplant for closure of refractory large macular holes (MHs).
Multicenter, retrospective, consecutive case series.
A total of 41 eyes of 41 patients with a full-thickness MH refractory to prior vitrectomy with internal limiting membrane (ILM) peel and tamponade.
All patients underwent pars plana vitrectomy, autologous neurosensory retinal transplant with gas, silicone oil tamponade, or short-term perfluoro-n-octane heavy-liquid tamponade. All patients had at least 6 months’ follow-up.
Anatomic closure of MH, change in ellipsoid zone (EZ) and external limiting membrane (ELM) defect on OCT, visual acuity (VA) recovery, and surgical complications were analyzed.
Mean number of prior surgeries was 1.5±0.94 (range, 1–3), and patients were followed for a mean of 11.1±7.7 months (range, 6–36 months). Complete anatomic closure of MH by OCT was achieved in 36 of 41 eyes (87.8%). Mean corrected VA (logarithm of the minimum angle of resolution [logMAR]) improved (P = 0.03) from 1.11±0.66 (range, 0.48–3) to 1.03±0.51 (range, 0.1–2) at the last postoperative visit. The VA improved (≥0.3 logMAR units) in 15 eyes (36.6%), was stable in 17 eyes (41.5%), and worsened in 9 eyes (21.9%). Among eyes with anatomic closure, VA improved in 52.3% and worsened in 13.8%, whereas in those without closure, VA worsened in 40% and improved in none. Mean preoperative largest basal diameter was 1468.1±656.4 μm (range, 621–2600 μm), and mean inner-opening diameter was 825±422.5 μm (range, 336–1649 μm). Mean preoperative EZ defect was 1777.3±513.8 μm (range, 963–2808 μm), which decreased to 1370±556.9 μm (range, 288–2000 μm) at final follow-up (P = 0.007). Mean preoperative ELM was 1681.5±429 μm (range, 1172–2606 μm), which decreased to 1408.5±571.2 μm (range, 200–2000 μm) at final follow-up (P = 0.017). Major postoperative complications were retinal detachment (n = 1) and vitreous hemorrhage (n = 1). There were no cases of proliferative vitreoretinopathy, endophthalmitis, suprachoroidal hemorrhage, or choroidal neovascularization.
The autologous retinal transplant technique offers a high degree of anatomic success and proved safe in this initial experience for closure of refractory MHs.
MEDIUM-TERM PERFLUORO-N-OCTANE AS RESCUE POSTOPERATIVE TAMPONADE FOR VERY COMPLEX RETINAL DETACHMENTS: ANATOMICAL AND FUNCTIONAL OUTCOMES
2023, Retina
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Shunji Kusaka, MD is a Professor of Ophthalmology at Sakai Hospital Kinki University Faculty of Medicine, Sakai, Japan. Dr Kusaka completed his residency in Ophthalmology at Osaka University and his fellowship training in vitreoretinal surgery at Osaka National Hospital. After finishing research fellowship program at University of Michigan, he continues clinical research in vitreoretinal diseases in Japan. His research interests include treatment of various vitreoretinal disorders, especially pediatric retinal diseases.

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Original articleEfficacy of Short-term Postoperative Perfluoro-n-octane Tamponade for Pediatric Complex Retinal Detachment

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Case Report 1

Discussion

Ophthalmology

Ophthalmology

Pediatric vs adult retinal detachment

Eye

Effect of silicone oil on experimental traction retinal detachment

Arch Ophthalmol

Fibroblast behavior at aqueous interfaces with perfluorocarbon, silicone and fluorosilicone liquids

Invest Ophthalmol Vis Sci

Management of giant retinal tears using perfluorodecaline as a postoperative short-term vitreoretinal tamponade: a long-term follow-up study

Ophthalmic Surg

Vitrectomy with short-term postoperative tamponade using perfluorocarbon liquid for giant retinal tears

Br J Ophthalmol

Original article
Efficacy of Short-term Postoperative Perfluoro-n-octane Tamponade for Pediatric Complex Retinal Detachment