Skip to main content

Advertisement

SpringerLink
Log in

Perfluorocarbon-perfused vitrectomy: a new method for vitrectomy—a safety and feasibility study

  • Clinical Investigation
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the safety and feasibility of perfluorocarbon-perfused vitrectomy (PCPV) as a technique during vitrectomy for proliferative diabetic retinopathy (PDR) and rhegmatogenous retinal detachment (RRD).

Methods

In an experimental, prospective, noncomparative and interventional study, 28 eyes of 28 patients were submitted to vitrectomy with the PCPV technique, 18 eyes with PDR and 10 with RRD. In this technique we replaced the traditional balanced saline solution (BSS) in the infusion line (conventional vitrectomy) by perfluorocarbon liquids (PCL). Some patients with PDR were treated with oxygenated PCL. Clinical evaluation, electroretinography (ERG), and endothelial cell count (ECC) were used to assess the safety of this procedure. An arbitrary grading system (grades 0–5) was used to classify the surgery and maneuvers to assess feasibility.

Results

No eyes had a significant decrease in ECC, and the patients in whom we could obtain ERG postoperatively showed no significant differences from preoperative ERG. In the PDR group (using oxygenated and nonoxygenated PCL), 77.8% were graded 5/5; in the RRD group 90% were 5/5. PCPV allowed better visualization of vitreous and intraocular structures, rapid retinal reattachment, less blood in the vitreous cavity, subretinal fluid resolution, blood confinement, retinal stabilization, and easier dissection of epiretinal membranes. In all cases at least one surgical step was eliminated.

Conclusions

PCPV in humans is a safe and feasible technique. Probably in selected cases the use of PCL offers several advantages over BSS, because of their properties (gravitational forces, immiscibility with bodily fluids, and ability to transport oxygen). Prospective and comparative studies are necessary to establish formal indications and possible contraindications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Blair NP, Baker DS, Rhode JP, Solomon M (1989) Vitreoperfusion. A new approach to ocular ischemia. Arch Ophthalmol 107:417–423

    Google Scholar 

  2. Blair NP (2000) Ocular oxygen consumption during vitreoperfusion in the cat. Trans Am Ophthalmol Soc 98:305–329

    CAS  PubMed  Google Scholar 

  3. Berrocal MH, Chang S (1994) Perfluorocarbon liquids in vitreous surgery. Ophthalmol Clin North Am 7:67–76

    Google Scholar 

  4. Chang S (1987) Low viscosity liquid fluorochemicals in vitreous surgery. Am J Ophthalmol 103:38

    Google Scholar 

  5. Chang S, Zimmerman NJ, Iwamoto T, et al (1987) Experimental vitreous replacement with perfluorotributylamine. Am J Ophthalmol 103:29–37

    CAS  PubMed  Google Scholar 

  6. Chang S, Ozmert E, Zimmerman NJ (1988) Intraoperative perfluorocarbon liquids in the management of proliferative vitreoretinopathy. Am J Ophthalmol 106:668–674

    CAS  PubMed  Google Scholar 

  7. Chang S, Lincoff h Zimmerman NJ, Fuchs W (1989) Giant retinal tears: surgical techniques and results using perfluorocarbon liquids. Arch Ophthalmol 107:761–766

    Google Scholar 

  8. Charles S (2002) Vitreous microsurgery, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 18–39

    Google Scholar 

  9. Clark LC, Gollan F (1966) Survival of mammals breathing organic liquids equilibrated with oxygen at atmosphere pressure. Science 152:1755–1756

    CAS  PubMed  Google Scholar 

  10. Clark LC Jr (1984) Methods of treating disorders of an eye with liquid perfluorocarbons. US Patent [407]4,490,351

  11. Corcostegui B (1992) Use of perfluorocarbon liquid in vitrectomy for diabetic rhegmatogenous retinal detachment. J Vitr Retina 1:30–34

    Google Scholar 

  12. De Juan E Jr, McCuen B, Tiedeman J (1985) Intraocular tamponade and surface tension. Surv Ophthalmol 30:47–51

    Article  PubMed  Google Scholar 

  13. Desai UR, Peyman GA, Harper CA III, Alturki WA (1992)The use of Vitreon® in the removal of massive vitreous hemorrhage caused by perforating ocular trauma (abstract). Invest Ophthalmol Vis Sci 33 [Suppl]:1314

    Google Scholar 

  14. Desai UR, Peyman GA, Harper CA III (1993) Perfluorocarbons liquids in traumatic vitreous hemorrhage and retinal detachment. Ophthalmic Surg 24:537–541

    Google Scholar 

  15. Forlini C, Del Fiume E, Cicognani A, D’Eliseo D (1992) Use of PFCL in the surgical management of endophthalmitis: new indicators. J Vitr Retina 1:55–63

    Google Scholar 

  16. Gould SA, Rosen AL, Sehgal LR, et al (1986) Fluosol-DA as a red cell substitute in acute anemia. N Engl J Med 314:1653–1656

    CAS  PubMed  Google Scholar 

  17. Greve MD, Peyman GA, Mehta NJ, Millsap CM (1993) Use of perfluoperhydrophenanthrene in the management of posteriorly dislocated crystalline and intraocular lenses. Ophthalmic Surg 24:593–597

    CAS  PubMed  Google Scholar 

  18. Haidt SJ, Clark LC Jr, Ginsberg J (1982) Liquid perfluorocarbon replacement of the eye (abstract). Invest Ophthalmol Vis Sci 22 [Suppl]:233

    Google Scholar 

  19. Heimann K (1993) Combined intraocular PFCL plus silicone oil tamponade for control of intraoperative hemorrhages (sandwich technique). Vitreoretinal Surg Technol 5:8

    Google Scholar 

  20. Lambert HM, Capone A Jr, Aaberg TM, et al (1992) Surgical excision of subfoveal neovascular membranes in age-related macular degeneration. Am J Ophthalmol 113:257–262

    CAS  PubMed  Google Scholar 

  21. Liu KR, Peyman GA, Chen M, Cheng K (1991) Use of high density vitreous substitutes in the removal of posteriorly lenses or intraocular lenses. Ophthalmology 22:503–507

    CAS  Google Scholar 

  22. Machemer R, Buettner H, Norton EWD, et al (1971) Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol 75(4):813–820

    CAS  PubMed  Google Scholar 

  23. McDonagh P, Cerney K, Hokama J, et al (2001) Perflubron emulsion reduces inflammation during extracorporeal circulation. J Surg Res 99:7–16

    Article  CAS  PubMed  Google Scholar 

  24. Millsap CM, Peyman GA, Ma PE, Greve MDJ (1994) The surgical management of retinopathy of prematurity using a perfluorocarbon liquid. Int Ophthalmol 18:97–100

    CAS  PubMed  Google Scholar 

  25. Nabih M, Peyman GA, Clark LC Jr, et al (1989) Experimental evaluation of perfluorophenanthrene as a high specific gravity vitreous substitute: a preliminary report. Ophthalmic Surg 20:286

    PubMed  Google Scholar 

  26. Nakstad B, Wolfson MR, Shaffer TH, et al (2001) Perfluorochemical liquids modulate cell-mediated inflammatory responses. Crit Care Med 29:1731–1737

    Article  CAS  PubMed  Google Scholar 

  27. O’Malley C, Heintz RM (1972) Vitrectomy via the pars plana—a new instrument system. Trans Pac Coast Oto-Ophthalmol Soc 53:121–137

    Google Scholar 

  28. Opremcak EM, Bruce RA (1999) Surgical decompression of branch retinal vein occlusion via arteriovenous crossing sheatotomy. Retina 19:1–5

    CAS  PubMed  Google Scholar 

  29. Opremcak E, Opremcak EM, Bruce RA, Lomeo MD, Ridenour CD, Letson AD, Rehmar AJ (2001) Radial optic neurotomy for central vein occlusion: a prospective pilot study of 11 consecutive cases. Retina 21(5):408–415

    Article  PubMed  Google Scholar 

  30. Osterloh MD, Charles S (1988) Surgical decompression of branch retinal vein occlusions. Arch Ophthalmol 106:1469–1471

    Google Scholar 

  31. Parel JM, Machemer R, Aumayr W (1974) A new concept for vitreous surgery. Improvements in instrumentation and illumination. Am J Ophthalmol 77(1):6–12

    Google Scholar 

  32. Peyman GA, Schulman JA (1986) Intravitreal surgery: principles and practice. CT Appleton Century-Crofts, Norwalk, p 384

    Google Scholar 

  33. Quiroz-Mercado H, Suarez-Tatá L, Magdalenic R, Murillo-López S, García-Aguirre G, Guerrero-Naranjo J, Rodríguez-Reyes A (2004) Perfluorocarbon perfused vitrectomy: animal studies. Am J Ophthalmol 137(2):287–293

    Google Scholar 

  34. Quiroz H (1998) Vitrectomy and erbium-Yag laser retinochoroidal shunts for the treatment of central vein occlusion. Retina Society 31st Annual Scientific Meeting. Washington D.C., September 24–27

  35. Resnick KI, Shapiro MJ, Kim S (1991) Perfluorooctane as an instrument to manipulate intraocular foreign bodies (abstract). Invest Ophthalmol Vis Sci 32(suppl):881

    Google Scholar 

  36. Shaffer TH, Wolfson MR, Clark LC Jr (1992) State of the art review: liquid ventilation. Pediatr Pulmonol 14:102–109

    CAS  PubMed  Google Scholar 

  37. Spiess BD, Cochran RP (1996) Perfluorocarbon emulsion and cardiopulmonary bypass: a technique for the future. J Cardiothorac Vasc Anesth 10:83–90

    CAS  PubMed  Google Scholar 

  38. Suarez Tatá L, Quiroz-Mercado H, Murillo S, et al (2002) Inflammatory reaction after vitrectomy with perfluorocarbons vs. saline solution in experimental endophthalmitis. Rev Soc Mex Ophthalmol 76:178–183

    Google Scholar 

  39. Velikay M, Stolba U, Wedrich A, Li Y, Datlinger P, Binder S (1995) The effect of chemical stability and purification of perfluorocarbon liquids in experimental extended-term vitreous substitution. Graefes Arch Clin Exp Ophthalmol 233:26–30

    Google Scholar 

  40. Velikay M, Wedrich A, Stolba U, Datlinger P, Li Y, Binder S (1993) Experimental long-term vitreous replacement with purified and nonpurified perfluorodecalin. Am J Ophthalmol 116:565–570

    CAS  PubMed  Google Scholar 

  41. Van Effenterre G, Le Mer Y, Lacotte JL, Ameline B (1992) Luxation posterieure du cristallin ou d’un implant: traitment chirurgical utilisant un perfluorocarbone liquide. J Fr Ophtalmol 15:337–342

    PubMed  Google Scholar 

  42. Wilson CA, Berkowitz BA, Srebro R (1995) Perfluorinated organic liquid as an intraocular oxygen reservoir for the ischemic retina. Invest Ophthalmol Vis Sci 36:131–141

    Google Scholar 

  43. Wilson CA, Berkowitz BA, McCuen BW, Charles HC (1992) Measurement of preretinal oxygen tension in the vitrectomized human eye using fluorine-19 magnetic resonance spectroscopy. Arch Ophthalmol 110:1098–1100

    Google Scholar 

  44. Wong D, Lois N (2000) Perfluorocarbons and semifluorinated alkanes. Semin Ophthalmol 15:25–35

    CAS  Google Scholar 

  45. Zimmerman NJ, Faris D (1984) The use of N-perfluorocarbon amines in complicated retinal detachments (abstract). Invest Ophthalmol Vis Sci 25 [Suppl]:258

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Retina Service, Asociación para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Vicente García Torres 46, México, 04330, Mexico

    Hugo Quiroz-Mercado, J. Guerrero-Naranjo, R. Agurto-Rivera, C. Leizaola-Fernández, L. Suárez-Tatá, S. Murillo-López, G. Reategui-Escalante, G. García-Aguirre & J. Fromow-Guerra

Authors
  1. Hugo Quiroz-Mercado
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Guerrero-Naranjo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Agurto-Rivera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Leizaola-Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. Suárez-Tatá
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Murillo-López
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Reategui-Escalante
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. García-Aguirre
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. Fromow-Guerra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hugo Quiroz-Mercado.

Additional information

Presented in part at the Jules Gonin Meeting, 2 September 2002, in Montreux, Switzerland.

The authors have no proprietary interest in any aspect of this report.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quiroz-Mercado, H., Guerrero-Naranjo, J., Agurto-Rivera, R. et al. Perfluorocarbon-perfused vitrectomy: a new method for vitrectomy—a safety and feasibility study. Graefe's Arch Clin Exp Ophthalmol 243, 551–562 (2005). https://doi.org/10.1007/s00417-004-1063-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-004-1063-z

Keywords

Search

Navigation