Wilbanks G A, Apel A J, Jolly S S, Devenyi R G, Rootman D S
Department of Ophthalmology, University of Toronto Faculty of Medicine, Ontario, Canada.
Cornea. 1996 May;15(3):329-34. doi: 10.1097/00003226-199605000-00017.
Perfluorodecalin is a perfluorocarbon liquid used intraoperatively in retinal detachment repair. It is usually removed at the end of the procedure; however, residual amounts may be retained when poor corneal clarity or intraocular hemorrhage obscures the view. No clinical reports exist on the consequences of retained perfluorodecalin in the anterior segment. We report five cases in which perfluorodecalin was in prolonged contact with the cornea. The period of time for corneal pathology to occur and the role perfluorodecalin played in the etiology of such changes is discussed. A total of 348 patients with retinal detachments in one retinal practice underwent repair using pars plana vitrectomy combined with intraoperative perfluorodecalin between January 1992 and May 1994. Postoperatively, residual perfluorodecalin was observed in the anterior chamber in contact with the corneal endothelium in five patients. The patients were followed clinically for a period of up to 18 months. Four of five patients developed corneal changes from prolonged contact with perfluorodecalin. Corneal edema developed in the area perfluorodecalin-endothelial contact in three of five eyes. The period of perfluorodecalin-endothelial contact before corneal decompensation occurred ranged from 4 to 13 weeks. Two eyes required penetrating keratoplasties for progressive corneal edema. Corneal edema was reversed in one eye after removal of perfluorodecalin from the anterior chamber via multiple paracentesis. One of the remaining eyes developed deep corneal vascularization without edema in the area of perfluorodecalin contact after 12 months. These observations suggest that corneal toxicity may be induced by intraocular perfluorodecalin if it is allowed direct contact with the corneal endothelium for periods as short as 1 month. Some of these changes may be reversible if perfluorodecalin is aspirated from the anterior chamber. Further investigations are required to examine perfluorodecalin-induced corneal toxicity.
全氟萘烷是一种全氟化碳液体，在视网膜脱离修复手术中用作术中用药。通常在手术结束时将其清除；然而，当角膜透明度差或眼内出血使视野模糊时，可能会残留一定量。目前尚无关于前段残留全氟萘烷后果的临床报告。我们报告了5例全氟萘烷与角膜长时间接触的病例。讨论了角膜病变发生的时间以及全氟萘烷在这种变化病因中所起的作用。1992年1月至1994年5月期间，一家视网膜诊所的348例视网膜脱离患者接受了玻璃体切除术联合术中使用全氟萘烷的修复手术。术后，在5例患者的前房中观察到残留的全氟萘烷与角膜内皮接触。对这些患者进行了长达18个月的临床随访。5例患者中有4例因全氟萘烷与角膜长时间接触而出现角膜变化。5只眼中有3只眼在全氟萘烷与内皮接触的区域出现角膜水肿。角膜失代偿发生前全氟萘烷与内皮接触的时间为4至13周。2只眼因进行性角膜水肿需要行穿透性角膜移植术。通过多次前房穿刺从前房中取出全氟萘烷后，1只眼的角膜水肿得到逆转。剩余的1只眼中，12个月后在全氟萘烷接触区域出现了深层角膜血管化但无水肿。这些观察结果表明，如果眼内全氟萘烷与角膜内皮直接接触的时间短至1个月，可能会诱发角膜毒性。如果从前房中吸出全氟萘烷，其中一些变化可能是可逆的。需要进一步研究来检查全氟萘烷引起的角膜毒性。
