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Gatto C, Giurgola L, Rodella U, Rossi O, Honisch C, Ruzza P, Ragazzi E, D'Amato Tóthová J. Selective ILM Staining and Safety of Two Vital Dyes During a Human-Like Pars Plana Vitrectomy Ex Vivo in Porcine Eyes. Curr Eye Res 2024; 49:615-623. [PMID: 38362897 DOI: 10.1080/02713683.2024.2309248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE An ideal dye for intraocular use should effectively stain the target tissue while being easy to apply and remove. Additionally, it should not have any adverse effects resulting from prolonged contact with the retinal tissue. Recently, concerns have been raised about the safety of some vital dyes during surgical procedures as they may cross the internal limiting membrane and deposit on the retina. In this study, we aimed to investigate whether commercially available vital dyes, VIEW-ILM® and TWIN® (AL.CHI.MI.A. S.r.l., Ponte San Nicolò, Padova, Italy), have the potential to cross the internal limiting membrane during vitreoretinal surgery and deposit on the retina. Furthermore, we evaluated their safety in vitro and in vivo. METHODS A human-like pars plana vitrectomy was performed on porcine eyes ex vivo, with VIEW-ILM® or TWIN® used to stain the internal limiting membrane either with or without subsequent internal limiting membrane peeling. The two dyes were then extracted from retinal punches with or without internal limiting membrane, and quantified using high performance liquid chromatography. Safety was evaluated through in vitro cytotoxicity tests and in vivo skin sensitization and irritation tests according to ISO standards. RESULTS High performance liquid chromatography analyses demonstrated that VIEW-ILM® and TWIN® effectively stained the internal limiting membrane without crossing the membrane. No residual dyes were found in the retinal layers after internal limiting membrane removal. Furthermore, both in vitro and in vivo safety tests confirmed the absence of cytotoxicity, skin sensitization, and irritation. CONCLUSION The results of this study support the safety and efficacy of VIEW-ILM® and TWIN® for internal limiting membrane staining. The experimental protocol described in this study could be utilized to gain a comprehensive understanding of the characteristics of vital dyes.
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Affiliation(s)
- Claudio Gatto
- Research and Development, AL.CHI.MI.A. S.r.l, Ponte San Nicolò, Italy
| | - Laura Giurgola
- Research and Development, AL.CHI.MI.A. S.r.l, Ponte San Nicolò, Italy
| | - Umberto Rodella
- Research and Development, AL.CHI.MI.A. S.r.l, Ponte San Nicolò, Italy
| | - Orietta Rossi
- Research and Development, AL.CHI.MI.A. S.r.l, Ponte San Nicolò, Italy
| | - Claudia Honisch
- Institute of Biomolecular Chemistry of CNR, Padua Unit, Padua, Italy
| | - Paolo Ruzza
- Institute of Biomolecular Chemistry of CNR, Padua Unit, Padua, Italy
| | - Eugenio Ragazzi
- Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, Padova, Italy
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Srivastava GK, Martinez-Rodriguez S, Md Fadilah NI, Looi Qi Hao D, Markey G, Shukla P, Fauzi MB, Panetsos F. Progress in Wound-Healing Products Based on Natural Compounds, Stem Cells, and MicroRNA-Based Biopolymers in the European, USA, and Asian Markets: Opportunities, Barriers, and Regulatory Issues. Polymers (Basel) 2024; 16:1280. [PMID: 38732749 PMCID: PMC11085499 DOI: 10.3390/polym16091280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024] Open
Abstract
Wounds are breaks in the continuity of the skin and underlying tissues, resulting from external causes such as cuts, blows, impacts, or surgical interventions. Countless individuals suffer minor to severe injuries, with unfortunate cases even leading to death. In today's scenario, several commercial products are available to facilitate the healing process of wounds, although chronic wounds still present more challenges than acute wounds. Nevertheless, the huge demand for wound-care products within the healthcare sector has given rise to a rapidly growing market, fostering continuous research and development endeavors for innovative wound-healing solutions. Today, there are many commercially available products including those based on natural biopolymers, stem cells, and microRNAs that promote healing from wounds. This article explores the recent breakthroughs in wound-healing products that harness the potential of natural biopolymers, stem cells, and microRNAs. A comprehensive exploration is undertaken, covering not only commercially available products but also those still in the research phase. Additionally, we provide a thorough examination of the opportunities, obstacles, and regulatory considerations influencing the potential commercialization of wound-healing products across the diverse markets of Europe, America, and Asia.
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Affiliation(s)
- Girish K. Srivastava
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, 47005 Valladolid, Spain;
- Instituto Universitario de Oftalmobiología Aplicada, Facultad de Medicina, Universidad de Valladolid, 47011 Valladolid, Spain;
| | - Sofia Martinez-Rodriguez
- Instituto Universitario de Oftalmobiología Aplicada, Facultad de Medicina, Universidad de Valladolid, 47011 Valladolid, Spain;
| | - Nur Izzah Md Fadilah
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (N.I.M.F.); (D.L.Q.H.); (M.B.F.)
| | - Daniel Looi Qi Hao
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (N.I.M.F.); (D.L.Q.H.); (M.B.F.)
- My Cytohealth Sdn. Bhd., Kuala Lumpur 56000, Malaysia
| | - Gavin Markey
- Personalised Medicine Centre, School of Medicine, Ulster University, C-TRIC Building, Altnagelvin Area Hospital, Glenshane Road, Londonderry BT47 6SB, UK; (G.M.); (P.S.)
| | - Priyank Shukla
- Personalised Medicine Centre, School of Medicine, Ulster University, C-TRIC Building, Altnagelvin Area Hospital, Glenshane Road, Londonderry BT47 6SB, UK; (G.M.); (P.S.)
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (N.I.M.F.); (D.L.Q.H.); (M.B.F.)
| | - Fivos Panetsos
- Neurocomputing and Neurorobotics Research Group, Faculty of Biology and Faculty of Optics, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Institute for Health Research San Carlos Clinical Hospital (IdISSC), 28040 Madrid, Spain
- Silk Biomed SL, 28260 Madrid, Spain
- Bioactive Surfaces SL, 28260 Madrid, Spain
- Omnia Mater SL, 28009 Madrid, Spain
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Ferrara M, Steel DH, Romano MR. A minimum specification dataset for liquid ocular endotamponades: recommendations by a European expert panel. Graefes Arch Clin Exp Ophthalmol 2024; 262:1141-1149. [PMID: 38038728 PMCID: PMC10995036 DOI: 10.1007/s00417-023-06289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023] Open
Abstract
PURPOSE To propose a minimum specification dataset to characterize liquid ocular endotamponades (OEs), namely silicone oil (SO), heavy SO (HSO), perfluorodecalin (PFD), and perfluoro-octane (PFO), in terms of physicochemical properties, purity and available evidence of safety, in line with ISO16672:2020. METHODS An evidence-based consensus using the expert panel technique was conducted. Two facilitators led a committee of 11 European experts. Facilitators prepared a dataset for each compound including the list of specifications relevant for the safety, identified by the group members on the basis of expertise and a comprehensive literature review. Each item was ranked by each member using a 9-point scale from 1 "absolutely to not include" to 9 "absolutely to include" in two rounds followed by discussion. Only items reaching consensus (score ≥ 7 from ≥ 75% of members) were included in the final datasets. RESULTS For all OEs, consensus was reached to include manufacturer, density, refractive index, chemical composition, dynamic viscosity, interfacial and surface tension, endotoxins, in vitro cytotoxicity assessment, and any evidence from ex vivo and/or in vivo tests for safety assessment. Additional specifications were added for SO (molecular weight distribution, content of oligosiloxanes with MW ≤ 1000 g/mol, spectral transmittance) and PFD/PFO (% of pure PFD/PFO in the final product, vapor pressure, chemical analyses performed for safety assessment). CONCLUSION The proposed evidence-based minimum specification datasets for SO, HSO, PFD, and PFO have the potential to provide surgeons and health service purchasers with an easily available overview of the most relevant information for the safety assessment of OEs.
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Affiliation(s)
| | - David Hw Steel
- Sunderland Eye Infirmary, Sunderland, UK.
- Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Ophthalmology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
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Papachristou A, Lambraki A, Giannakopoulou T, Tsilimbaris MK, Plainis S. Silicone oil insulation effects on flash electroretinogram and visual evoked potential in patients with retinal detachment. JOURNAL OF OPTOMETRY 2024; 17:100502. [PMID: 37931571 PMCID: PMC10654225 DOI: 10.1016/j.optom.2023.100502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/20/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Silicone oil is used as endotamponade following vitreoretinal surgery to maintain the retina reattached when indicated. This study investigates the hypothesis that silicone oil causes insulation effects on the retina by affecting its response to light. METHODS Electrophysiological responses to a flash stimulus were recorded using full-field electroretinography (ERG) and visual evoked potentials (VEP). Recordings were performed in 9 patients who underwent surgery for retinal detachment, before (1-2 days) and after (2-3 weeks) silicone oil removal (SOR) in both the study and the control eye. Flash ERG and VEP recordings were performed according to the ISCEV standard protocol. RESULTS Statistically significant differences were found in the study eye in the amplitudes of the ERG responses and their corresponding ratios, i.e. the amplitude after SOR over the amplitude before SOR, in all conditions tested. No differences were observed in the control eye. The mean ratio of photopic ERG response was 3.4 ± 2.4 for the study and 1.0 ± 0.3 for the control eye (p<0.001). The mean ratio of ERG flicker response was 3.1 ± 2.4 and 1.0 ± 0.3, respectively (p = 0.003). Scotopic flash ERG ratio was 5.0 ± 4.4 for the study and 1.3 ± 0.6 for the control eye (p = 0.012). No differences were observed for the amplitude and latency of flash VEP response after SOR. CONCLUSIONS Silicone oil causes a reduction in flash ERG responses; no effect was found on flash VEP responses. ERGs in eyes filled with silicone oil should not be considered representative of retinal functionality, in contrast to VEPs, which are not affected by silicone oil presence.
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Affiliation(s)
- Anastasia Papachristou
- Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Greece
- Ophthalmology Department, University Hospital of Heraklion, Crete, Greece
| | - Argiri Lambraki
- Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Greece
| | - Trisevgeni Giannakopoulou
- Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Greece
- Ophthalmology Department, University Hospital of Heraklion, Crete, Greece
| | - Miltiadis K. Tsilimbaris
- Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Greece
- Ophthalmology Department, University Hospital of Heraklion, Crete, Greece
| | - Sotiris Plainis
- Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Greece
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Dsouza P, Mohan M, Mohanakumar M, ShivaSwamy M, Kanakath A, Vr S. Pits of Fire: Post Scleral Graft Vasculitis in Patients With Optic Disc Pit Maculopathy. Ophthalmic Surg Lasers Imaging Retina 2024; 55:172-175. [PMID: 38270571 DOI: 10.3928/23258160-20240112-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Occlusive vasculitis is a rare complication following an uneventful surgery. In this article, we report two cases of optic disc pit maculopathy that underwent scleral graft and developed vasculitis following uneventful surgery. Both patients underwent autologous scleral graft for optic disc pit maculopathy through 25-gauge pars plana vitrectomy. Scleral graft was harvested from patient's same eye and plugged in the optic disc pit. After a postoperative period of approximately 3 months, both patients developed features of occlusive vasculitis with vitreous base contraction. Uveitic workup did not reveal other causes of vasculitis. Both patients were treated with topical and systemic steroids and responded well until the last follow-up. [Ophthalmic Surg Lasers Imaging Retina 2024;55:172-175.].
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Adrean SD, Peng ET, Chaili S, Grant S. PURPOSEFUL GAS-INDUCED RESORPTION OF SUBMACULAR FLUID IN MACULA-OFF RETINAL DETACHMENTS (PERSIMMON STUDY). Retina 2024; 44:414-420. [PMID: 37972942 DOI: 10.1097/iae.0000000000003996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE To examine the visual outcomes in patients with macula-off rhegmatogenous retinal detachments with intentional submacular fluid retention after pars plana vitrectomy (PPV) or PPV/scleral buckle surgery (PPV/SB). METHODS Patients with macula-off retinal detachments were included if they had a PPV or PPV/SB without drainage retinotomy or perfluorocarbon liquid to flatten the retina. RESULTS The mean age of the patients was 65.0 years. The mean presenting vision was 20.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Six months after repair, the vision improved to 62.9; 75.4% of patients had 20/40 or better at best achieved visual acuity. Pseudophakic eyes had better vision compared with phakic eyes ( P = 0.049). Patients younger than 80 years had better best achieved vision ( P = 0.0118) compared with patients 80 years or older. Patients with initial vision better than or equal to 20/100 had better best achieved vision ( P = 0.016) compared with those with initial vision worse than 20/100. CONCLUSION Leaving submacular fluid after macula-off retinal detachments surgery was not detrimental for visual outcomes or anatomic success for retinal detachments repair and may lead to better visual outcomes for patients, specifically for those patients younger than 80 years, who are pseudophakic, and have presenting vision 20/100 or better.
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Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, Fullerton, California
| | - Enoch T Peng
- Retina Consultants of Orange County, Fullerton, California
- University of Texas Southwestern Medical School, Dallas, Texas; and
| | - Siyang Chaili
- Retina Consultants of Orange County, Fullerton, California
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott Grant
- Retina Consultants of Orange County, Fullerton, California
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Andrés-Iglesias C, Fernandez-Bueno I, Pastor-Idoate S, Coco-Martin RM, Pastor JC. Ala ®sil chemical characterization and toxicity evaluation: an example of the need for the Medical Device Regulation 2017/745. Front Pharmacol 2024; 14:1310463. [PMID: 38283844 PMCID: PMC10811781 DOI: 10.3389/fphar.2023.1310463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction: Ala®sil infusion was on the market for clinical use under the Medical Devices Directive (MDD) 93/42/EEC as an irrigating solution based on polydimethylsiloxane (PDMS). The product was withdrawn in 2016, and to the best of our knowledge, it did not cause any health damage. Methods: A bibliographic review and experimental analysis were conducted to evaluate whether this CE-marked product could have been used in patients under the current Medical Device Regulation (MDR) 2017/745. Analytical results from gas chromatography-mass spectrometry (GC-MS) and matrixassisted laser desorption ionization (MALDI) were performed. Citotoxicity studies were also carried out. Results: Only one study related to Ala®sil clinical use was found, describing a pilot series of five patients. The authors rated the product as not helpful in three out of the five cases for internal searching of retinal breaks and in four out of the five cases for drainage of subretinal fluid. No other scientific papers or documentation was found regarding Ala®sil's safety. Nevertheless, the product was introduced in the market after achieving the CE marking. GC-MS and MALDI showed that the polymer has a low molecular weight of 1,000 g/mol. Several linear and cyclic low-molecular-weight components (LMWCs) were identified as impurities ranging from L3 to D8, with a molecular weight below 600 g/mol. The Ala®sil sample was found to be cytotoxic after 24 h of cell culture but non-cytotoxic after 72 h, probably due to the cellular regeneration capacity of an immortalized cell line. Tissular cytotoxicity revealed an increased apoptosis rate but without morphological modifications. Discussion: Although Ala®sil cannot be classified as cytotoxic, this substance appears to increase retinal cell death processes. This study supports the notion that the MDDwas not functioning adequately to ensure the safety of medical devices. However, the current MDR 2017/745 imposes stricter standards to prevent the commercialization of medical devices without high-quality preclinical and clinical information, as well as precise clinical verification for their use, information not available for Ala®sil infusion.
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Affiliation(s)
- Cristina Andrés-Iglesias
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Retina Group, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Ivan Fernandez-Bueno
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Retina Group, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
- Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, Spain
| | - Salvador Pastor-Idoate
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Retina Group, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, Spain
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Rosa M. Coco-Martin
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Retina Group, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
- Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, Spain
| | - J. Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Retina Group, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
- Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, Spain
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Donate J, Arias-Barquet L, Ruiz-Casas D, Larra-Mateos E, Pastor JC. Reporting serious incidents in medical devices used in intraocular surgery: Proposing ideas. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:723-726. [PMID: 37865190 DOI: 10.1016/j.oftale.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/23/2023]
Abstract
The entry into force of the regulation on medical devices obliges clinicians to identify and report to the Health Authorities possible serious incidents arising from their use. In view of the doubts that may arise as to whether or not it may be considered a serious incident, a working group, set up by members of the Spanish Society of Retina and Vitreo and the cluster of ophthalmology and vision sciences (Cluster4Eye) have prepared a document that aims to guide ophthalmologists about some of the incidents that, in the experience of the work team, are not common or can cause serious damage to the patient's function.
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Affiliation(s)
- J Donate
- Hospital La Luz, Quironsalud, Hospital Clínico San Carlos, Madrid, Spain
| | - L Arias-Barquet
- Hospital de Bellvitge, Universidad de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - D Ruiz-Casas
- Hospital Ramón y Cajal, Hospital HM Montepríncipe, Madrid, Spain
| | - E Larra-Mateos
- AJL Ophthalmic S.A., Vitoria, Spain; Cluster4Eye, Valladolid, Spain
| | - J C Pastor
- Cluster4Eye, Valladolid, Spain; IOBA, Universidad de Valladolid, Valladolid, Spain.
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Romano MR, Ferrara M, Coco-Martin RM, Rickmann A, Spitzer MS, Steel DHW, Pastor JC. INTRAOCULAR EMULSION OF SILICONE OIL (ITEMS) GRADING SYSTEM: An Evidence-Based Expert-Led Consensus. Retina 2023; 43:1370-1376. [PMID: 37071921 DOI: 10.1097/iae.0000000000003811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE To propose the InTraocular EMulsion of Silicone oil (ITEMS) grading system for the assessment of silicone oil (SiO) emulsion, applicable in a routine clinical setting and validated through an expert-led consensus procedure. METHODS Seven experts on intraocular liquid tamponades, led by a facilitator, performed a literature review on the detection of SiO emulsion. Based on the proposed ideas, a questionnaire was developed and submitted to the experts on the methods to detect SiO emulsion and the items to grade. After 2 rounds of individual ranking using a 9-point scale and related discussion, the final grading system was developed including items that reached consensus (score ≥7 from ≥75% of members). RESULTS The agreed ITEMS grading system includes the identification of SiO microbubbles and large SiO bubbles through slit-lamp biomicroscopy, gonioscopy, fundus examination under mydriasis, or ultra-wide-field fundus photography. Moreover, macular and disk optical coherence tomography are used to detect SiO-associated hyperreflective dots. CONCLUSION An evidence-based expert-led consensus was conducted to develop grading system of SiO emulsion, allowing, for the first time, homogenous collection of data on SiO emulsion. This has the potential to improve the understanding of the role and clinical relevance of SiO emulsion, allowing comparisons between different studies.
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Affiliation(s)
- Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
- Eye Center, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | | | - Rosa M Coco-Martin
- Retina Group, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Campus Miguel Delibes, Paseo de Belén, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla Y León, Valladolid, Spain
- RICORS de Enfermedades Inflamatorias, Carlos III National Institute of Health, Madrid, Spain
| | | | - Martin S Spitzer
- University Medical Center Hamburg-Eppendorf, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - David H W Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom; and
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - J Carlos Pastor
- Retina Group, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Campus Miguel Delibes, Paseo de Belén, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla Y León, Valladolid, Spain
- RICORS de Enfermedades Inflamatorias, Carlos III National Institute of Health, Madrid, Spain
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10
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Shukla D, Dhawan A, Kalliath J. MEDIUM-TERM PERFLUORO-N-OCTANE AS RESCUE POSTOPERATIVE TAMPONADE FOR VERY COMPLEX RETINAL DETACHMENTS: ANATOMICAL AND FUNCTIONAL OUTCOMES. Retina 2023; 43:905-912. [PMID: 36791344 DOI: 10.1097/iae.0000000000003763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE To report the anatomical and functional outcomes of medium-term perfluoro-n-octane (PFO) tamponade as a rescue procedure in very complex retinal detachments (RDs). METHODS We reviewed the case records of 35 consecutive patients who underwent vitrectomy for very complex RDs due to diverse etiologies. The surgical complexity was so graded because of the intraoperative failure to ascertain complete retinal reattachment; perfluoro-n-octane was used as rescue tamponade for 2 to 4 weeks. The second intervention included additional membrane peeling, retinectomy, endophotocoagulation, and gas/silicone oil tamponade. The minimum follow-up was 3 months after the final intervention: the primary outcome was retinal reattachment and the secondary outcome was change in best-corrected visual acuity (BCVA). RESULTS The most common presentations were severe trauma with retinal incarceration, preretinal and subretinal hemorrhage, or chronic/recurrent RDs with anterior proliferative vitreoretinopathy. Preoperative BCVA was ≤counting fingers in 31 (88.6%) patients. Complete retinal attachment without any tamponade was achieved in 33 (94.3%) eyes. best-corrected visual acuity improved in 30 (85.7%) eyes: 16 (45.7%) had BCVA ≥20/200 and 21 (60%) regained ambulatory vision (≥5/200). Two eyes developed keratopathy, and four needed antiglaucoma medications. CONCLUSION We achieved excellent anatomical outcomes and acceptable functional outcomes in nearly inoperable RDs with few side effects. Medium-term perfluoro-n-octane tamponade can be used as a salvage procedure in very complex RDs where intraoperative reattachment cannot be ensured.
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Affiliation(s)
| | - Anuradha Dhawan
- Calderdale Huddersfield Foundation NHS Trust Hospital, UK; and
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11
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Pastor Jimeno JC. AlaOcta, the story comes to its end. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023:S2173-5794(23)00026-9. [PMID: 36871849 DOI: 10.1016/j.oftale.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 03/07/2023]
Affiliation(s)
- J C Pastor Jimeno
- Doctor en Medicina y Cirugia, Profesor Emerito de la Universidad de Valladolid, Valladolid, Spain.
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12
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Vitreous Substitutes from Bench to the Operating Room in a Translational Approach: Review and Future Endeavors in Vitreoretinal Surgery. Int J Mol Sci 2023; 24:ijms24043342. [PMID: 36834754 PMCID: PMC9961686 DOI: 10.3390/ijms24043342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Vitreous substitutes are indispensable tools in vitreoretinal surgery. The two crucial functions of these substitutes are their ability to displace intravitreal fluid from the retinal surface and to allow the retina to adhere to the retinal pigment epithelium. Today, vitreoretinal surgeons can choose among a plethora of vitreous tamponades, and the tamponade of choice might be difficult to determine in the ever-expanding range of possibilities for a favorable outcome. The currently available vitreous substitutes have disadvantages that need to be addressed to improve the surgical outcome achievable today. Herein, the fundamental physical and chemical proprieties of all vitreous substitutes are reported, and their use and clinical applications are described alongside some surgical techniques of intra-operative manipulation. The major upcoming developments in vitreous substitutes are extensively discussed, keeping a translational perspective throughout. Conclusions on future perspectives are derived through an in-depth analysis of what is lacking today in terms of desired outcomes and biomaterials technology.
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Lazzara F, Conti F, Ferrara M, Lippera M, Coppola M, Rossi S, Drago F, Bucolo C, Romano MR. Safety Profile of Lutein- Versus Triamcinolone Acetonide-Based Vitreous Staining. Transl Vis Sci Technol 2023; 12:5. [PMID: 36598459 PMCID: PMC9832719 DOI: 10.1167/tvst.12.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose To assess the safety profile of a new lutein-based vitreous dye (LB-VD) formulation compared with various triamcinolone acetonide (TA) formulations with and without subsequent exposure to perfluorodecalin (PFD) in vitro. Methods Human adult retinal pigment epithelial cells (ARPE-19) were treated with the following formulations: undiluted preserved TA (TA-BA), diluted preserved TA (D-TA-BA), preservative-free TA (TA-PF), and LB-VD. First, cell tolerability was evaluated with MTT, LDH, and ATPlite assays after 1, 5, and 30 minutes of exposure to each tested formulation. Then, cells were sequentially exposed to formulations and PFD. After 24 hours of exposure to PFD, cell tolerability was evaluated through MTT and ATPlite assays. Results Among the formulations tested, LB-VD showed the highest levels of cell viability, cell metabolism, and cell proliferation and induced the lowest release of LDH, whereas the TA-based formulations demonstrated a cytotoxic effect on ARPE-19 cells in vitro. After subsequent 24-hour exposure to PFD, a greater reduction of cell viability was noted for all the formulations; however, this reduction was not significant only for the combination LB-VD-PFD, which was the best tolerated condition. Conclusions LB-VD showed a better safety profile compared with all TA-based formulations, even when used in combination with PFD. Translational Relevance In surgical practice, LB-VD may be preferred to TA-based formulations for vitreous staining in the light of its more favorable safety profile.
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Affiliation(s)
- Francesca Lazzara
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Federica Conti
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Mariantonia Ferrara
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Myrta Lippera
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Michele Coppola
- Department of Ophthalmology, San Gerardo Hospital, Monza, Italy
| | - Settimio Rossi
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy,Center for Research in Ocular Pharmacology–CERFO, University of Catania, Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy,Center for Research in Ocular Pharmacology–CERFO, University of Catania, Catania, Italy
| | - Mario R. Romano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy,Eye Center, Humanitas Gavazzeni-Castelli, Bergamo, Italy
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14
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Interfacial Dynamics of Adsorption Layers as Supports for Biomedical Research and Diagnostics. COLLOIDS AND INTERFACES 2022. [DOI: 10.3390/colloids6040081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The input of chemical and physical sciences to life sciences is increasingly important. Surface science as a complex multidisciplinary research area provides many relevant practical tools to support research in medicine. The tensiometry and surface rheology of human biological liquids as diagnostic tools have been very successfully applied. Additionally, for the characterization of pulmonary surfactants, this methodology is essential to deepen the insights into the functionality of the lungs and for the most efficient administration of certain drugs. Problems in ophthalmology can be addressed using surface science methods, such as the stability of the wetting films and the development of artificial tears. The serious problem of obesity is fast-developing in many industrial countries and must be better understood, while therapies for its treatment must also be developed. Finally, the application of fullerenes as a suitable system for detecting cancer in humans is discussed.
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15
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Retinal and Corneal Changes Associated with Intraocular Silicone Oil Tamponade. J Clin Med 2022; 11:jcm11175234. [PMID: 36079165 PMCID: PMC9457190 DOI: 10.3390/jcm11175234] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 12/22/2022] Open
Abstract
Silicone oils (SO) are used as long-term intraocular tamponades and have an irreplaceable role in vitreoretinal surgery. They can, however, be associated with multiple and potentially severe complications, involving different ocular tissues, in particular retina and cornea. Recent advances in ophthalmic imaging have allowed the precise characterization of retinal and corneal microstructural changes, at a subclinical level. This detailed analysis of SO-related retinal and corneal changes has improved our understanding of their pathogenesis and offer the potential for optimized monitoring and management of patients with SO-filled eyes. This review aims to provide clinicians and ophthalmic scientists with an updated and comprehensive overview of the corneal and retinal changes associated with SO tamponade.
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Wolf A, Romano MR, Haritoglou C. [Visual acuity reduction and silicone oil tamponade]. DIE OPHTHALMOLOGIE 2022; 119:781-788. [PMID: 35925362 DOI: 10.1007/s00347-022-01702-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
Silicone oil is an established intraocular surgical aid, which enables the treatment of the most complex starting situations but no other alternative has been found; however, the available data indicate that an unclear loss of visual acuity during or after an intraocular silicone oil tamponade possibly occurs more frequently than assumed from the clinical routine. Various pathological mechanisms are under discussion as causes, but the exact causes are actually unclear. In addition to atrophic alterations in the optical coherence tomography (OCT) examination, there are a clear reduction in visual acuity and mostly a central scotoma with otherwise inconspicuous findings. Unclear loss of visual acuity can also occur after removal of the silicone oil. Whether this is caused by the same pathological mechanism is unclear. Furthermore, there are no reproducible risk factors that appear a priori to possibly cause an unclear loss of vision under silicone oil; however, oil removal as soon as possible and a good adjustment of the intraocular pressure are recommended by the authors. Overall, a silicone oil tamponade should be carefully weighed up even when using modern highly purified silicone oils and it should therefore continue to be reserved particularly for unfavorable initial situations or complicated courses with the necessity for a silicone oil tamponade. Against this background, a study for systematic recording and processing of cases of unclear loss of visual acuity after silicone oil tamponade seems to be meaningful.
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Affiliation(s)
- Armin Wolf
- Augenklinik, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Deutschland.
| | - Mario R Romano
- Humanitas University, Via Montalcini 4 20090 Pieve Emanuele, Mailand, Italien
| | - Christos Haritoglou
- Augenklinik Herzog Carl Theodor, Nymphenburger Str. 43, 80335, München, Deutschland
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17
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Acute intraocular toxicity caused by perfluorocarbon liquids: safety control systems of medical devices. Graefes Arch Clin Exp Ophthalmol 2022; 260:2103-2110. [PMID: 35122500 PMCID: PMC8817148 DOI: 10.1007/s00417-022-05578-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Acute retinal toxicity has been demonstrated to be associated with the intraoperative use of perfluorocarbon liquids (PFCLs), especially perfluorooctane (PFO). Recently, several cases of PFO-associated blindness have been reported in Spain, Holland, France, Italy, the Middle East, and South America. METHODS As a result, a new ISO guideline (ISO 16672:2020) was drafted, discussed, approved, and released in 2019. This recent ISO16672:2020 guideline recommends performing direct cytotoxicity tests as an option along with chemical analysis to measure PFCL quality (purity and safety). RESULTS In this review paper, it has been emphasized why an appropriate biological test, specifically direct exposure of PFCL to live cells, for measuring cytotoxicity must be performed with each PFCL batch along with chemical analysis. CONCLUSIONS The paper intends to compile all available information to discuss possible approaches for avoiding adverse clinical cases in future.
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18
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Gatto C, Romano MR, Giurgola L, Ferrara M, Ragazzi E, D'Amato Tothova J. Ex vivo evaluation of retinal cytotoxicity after the use of multiple medical devices in pars plana vitrectomy in porcine eyes. Exp Eye Res 2021; 213:108837. [PMID: 34774490 DOI: 10.1016/j.exer.2021.108837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/19/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022]
Abstract
This study aimed to evaluate viability of retinal cells after the use of multiple intraoperative devices, namely a vitreal dye (triamcinolone acetonide,TA), a ERM/ILM dye (solution of trypan blue 0.15% and brilliant blue 0.025%), and two intraocular tamponades, namely perfluoro-n-octane, (PFO) and silicone oil (SO 1000 cSt), with minimal and maximal removal of their residues, during a simulated pars plana vitrectomy (PPV) in porcine eyes ex-vivo. The in vitro cytotoxicity of each of these compounds was verified on ARPE-19 cells by direct tests according to the ISO 10993-5 (2009). Pars plana vitrectomy was performed on 25 enucleated porcine eyes divided in five groups according to the following conditions: Group A) No surgery control: eye bulbs were kept at room temperature for 40 min; Group B) Sham surgery: PPV with the sole use of BSS for 40 min; Group C) Cytotoxic control: PPV with BSS infusion (20 min) followed by intravitreal injection of 1H-PFO (contact time: 20 min); Group D) Surgery with residues: PPV with BSS infusion and sequential intravitreal injection of TA, ERM/ILM dye, PFO and SO, with minimal removal of each compound after a specified contact-time (overall duration: 40 min); Group E) Surgery with minimal residues: PPV performed as in group D, but with maximal removal of each compound (overall duration: 40 min). All the experimental procedures were performed at room temperature. Immediately after surgery, the retina was extracted from each eye bulb and samples of 3-mm diameter were prepared. Retinal viability was determined for each sample by 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide assay. A cell viability <70% was considered the cytotoxicity threshold. Kruskal-Wallis test was used to evaluate the differences in retinal viability between groups. No cytotoxicity was detected in retinal samples in groups A, B and E. Samples from eye bulbs that had undergone surgery with minimal removal of residues (group D) and cytotoxic controls (group C) showed high retinal cytotoxicity. The tested conditions indicated that the combined use of TA, ERM/ILM dye, PFO and SO during PPV does not affect retinal cells viability if all the devices are properly removed, whereas the cytotoxicity detected in group D may suggest that the presence and accumulation of the residues of the compounds used intraoperatively could negatively impact retinal viability due to a cumulative and/or synergistic cytotoxic effect between them, supporting the crucial role of an optimal removal of the intraoperative medical devices to ensure a safe vitrectomy to the patient.
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Affiliation(s)
- Claudio Gatto
- Research and Development AL.CHI.MI.A. S.r.l, Viale Austria 14, 35020, Ponte San Nicolò, PD, Italy.
| | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy; Eye Center, Humanitas Gavazzeni-Castelli, Via Gavazzeni 21, 24125, Bergamo, Italy.
| | - Laura Giurgola
- Research and Development AL.CHI.MI.A. S.r.l, Viale Austria 14, 35020, Ponte San Nicolò, PD, Italy.
| | - Mariantonia Ferrara
- Newcastle Eye Centre, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Eugenio Ragazzi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Largo Meneghetti 2, 35131, Padova, Italy.
| | - Jana D'Amato Tothova
- Research and Development AL.CHI.MI.A. S.r.l, Viale Austria 14, 35020, Ponte San Nicolò, PD, Italy.
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Sahoo NK, Behera S, Narayanan R, Chhablani J. Toxic Posterior Segment Syndrome Presenting as Occlusive Retinal Vasculitis following Vitreoretinal Surgery. J Curr Ophthalmol 2021; 33:345-348. [PMID: 34765826 PMCID: PMC8579792 DOI: 10.4103/joco.joco_42_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To report a rare retinal manifestation of toxic posterior segment syndrome following vitreoretinal surgery. Methods In this case series, we report three cases of rhegmatogenous retinal detachment for which pars plana vitrectomy with silicone oil injection was done. All three patients developed an intense anterior chamber reaction along with occlusive vasculitis-like fundus picture. Results The three patients were started on topical and systemic steroids, and there was a dramatic improvement in vision and clinical signs at postoperative week 1. Conclusion Toxic posterior segment syndrome is a sight-threatening complication after vitreoretinal surgery, but responds well to topical and systemic steroids.
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Affiliation(s)
- Niroj Kumar Sahoo
- Department of Retina and Vitreous, L. V. Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Tadigadapa, Vijayawada, Andhra Pradesh, India
| | - Shashwat Behera
- Department of Retina and Vitreous, L. V. Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Tadigadapa, Vijayawada, Andhra Pradesh, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Retina Vitreous Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India.,UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA
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20
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Mondelo-García C, Bandín-Vilar E, García-Quintanilla L, Castro-Balado A, Del Amo EM, Gil-Martínez M, Blanco-Teijeiro MJ, González-Barcia M, Zarra-Ferro I, Fernández-Ferreiro A, Otero-Espinar FJ. Current Situation and Challenges in Vitreous Substitutes. Macromol Biosci 2021; 21:e2100066. [PMID: 33987966 DOI: 10.1002/mabi.202100066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/23/2021] [Indexed: 12/11/2022]
Abstract
Vitreo-retinal disorders constitute a significant portion of treatable ocular diseases. These pathologies often require vitreo-retinal surgery and, as a consequence, the use of vitreous substitutes. Nowadays, the vitreous substitutes that are used in clinical practice are mainly divided into gases (air, SF6 , C2 F6 , C3 F8 ) and liquids (perfluorocarbon liquids, silicone oils, and heavy silicone oils). There are specific advantages and drawbacks to each of these, which determine their clinical indications. However, developing the ideal biomaterial for vitreous substitution continues to be one of the most important challenges in ophthalmology, and a multidisciplinary approach is required. In this sense, recent research has focused on the development of biocompatible, biodegradable, and injectable hydrogels (natural, synthetic, and smart), which also act as medium and long-term internal tamponade agents. This comprehensive review aims to cover the main characteristics and indications for use of the extensive range of vitreous substitutes that are currently used in clinical practice, before going on to describe the hydrogels that have been developed recently and which have emerged as promising biomaterials for vitreous substitution.
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Affiliation(s)
- Cristina Mondelo-García
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Enrique Bandín-Vilar
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Laura García-Quintanilla
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Ana Castro-Balado
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Eva M Del Amo
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, 70211, Finland
| | - María Gil-Martínez
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain
| | - María José Blanco-Teijeiro
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain
| | - Miguel González-Barcia
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Irene Zarra-Ferro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Francisco J Otero-Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, 15782, Spain
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21
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Intraocular toxicity caused by MEROCTANE perfluorocarbon liquid. Sci Rep 2021; 11:599. [PMID: 33436689 PMCID: PMC7804266 DOI: 10.1038/s41598-020-79561-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/03/2020] [Indexed: 11/08/2022] Open
Abstract
Serious intraocular toxicity cases have been reported worldwide after the use of different perfluorocarbon liquids. The current study reports for the first-time the clinical pictures of cases of acute intraocular toxicity caused by MEROCTANE, a perfluoro-octane commercialized by a Turkish company and distributed in many countries. A series of 18 cases from Chile and Spain was retrospectively analysed. To evaluate the impurity profile, a suspicious MEROCTANE sample (lot OCT.01.2013) was analysed by gas chromatography mass spectrometry and compared with a non-suspicious sample of the same commercial perfluoro-octane (lot OCT 722011). Cytotoxicity was tested following a direct-contact method, taking into consideration the high volatility and hydrophobicity of perfluoro-octane and following the ISO 10993 guideline. Cytotoxicity test showed clear cytotoxic effects of the analysed batch (less than 9% of cell viability). Moreover, chemical analysis demonstrated the presence of many contaminants, some highly toxic (acids and alcohols). Perfluorocarbon liquids are useful tools for intraocular surgery but companies and Agencies of Medical Devices must implement measures that guarantee the safety of these products based on both chemical and cytotoxicity analysis for every batch. Medical staff should be encouraged to report any suspected case to their respective National Agencies.
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22
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Andrés-Iglesias C, Pastor JC. Silicone oil safety is not only a purity question. Graefes Arch Clin Exp Ophthalmol 2020; 259:269-270. [PMID: 33034752 DOI: 10.1007/s00417-020-04965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 08/25/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Cristina Andrés-Iglesias
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, University of Valladolid, Valladolid, Spain. .,ISO Committee CTN 91, UNE, Madrid, Spain.
| | - José Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, University of Valladolid, Valladolid, Spain.,ISO Committee CTN 91, UNE, Madrid, Spain.,Expert Panels in the field of Medical Devices, European Commission, Valladolid, Spain.,Hospital Clínico Universitario, Valladolid, Spain
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23
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Steel DHW, Wong D, Sakamoto T. Silicone oils compared and found wanting. Graefes Arch Clin Exp Ophthalmol 2020; 259:11-12. [DOI: 10.1007/s00417-020-04810-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022] Open
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Spadaro A, Rao M, Lorenti M, Romano MR, Augello A, Eandi CM, Platania CBM, Drago F, Bucolo C. New Brilliant Blue G Derivative as Pharmacological Tool in Retinal Surgery. Front Pharmacol 2020; 11:708. [PMID: 32523529 PMCID: PMC7261835 DOI: 10.3389/fphar.2020.00708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
Our study was aimed at assessing the retinal binding of a new synthetic Brilliant Blue G (BBG) derivative (pure benzyl-Brilliant Blue G; PBB) ophthalmic formulation, to improve vitreoretinal surgery procedure. Protein affinity of the new molecule was evaluated in vitro (cell-free assay) and in silico. Furthermore, an ex vivo model of vitreoretinal surgery was developed by using porcine eyes to assess the pharmacological profile of PBB, compared to commercial formulations based on BBG and methyl-BBG (Me-BBG). PBB showed a higher affinity for proteins (p < 0.05), compared to BBG and Me-BBG. In vitro and in silico studies demonstrated that the high selectivity of PBB could be related to high lipophilicity and binding affinity to fibronectin, the main component of the retinal internal limiting membrane (ILM). The PBB staining capabilities were evaluated in porcine eyes in comparison with BBG and Me-BBG. Forty microliters of each formulation were slowly placed over the retinal surface and removed after 30 s. After that, ILM peeling was carried out, and the retina collected. BBG, Me-BBG, and PBB quantification in ILM and retina tissues was carried out by HPLC analysis. PBB levels in the ILM were significantly (p < 0.05) higher compared to BBG and Me-BBG formulations. On the contrary, PBB showed a much lower (p < 0.05) distribution in retina (52 ng/mg tissue) compared to BBG and Me-BBG, in particular PBB levels were significantly (p < 0.05) lower. Therefore, the new synthetic Brilliant Blue derivative (PBB) showed a great ILM selectivity in comparison to underneath retinal layers. In conclusion, these findings had high translational impact with a tangible improving in ex vivo model of retinal surgery, suggesting a future use during surgical practice.
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Affiliation(s)
- Angelo Spadaro
- Department of Drug Sciences, University of Catania, Catania, Italy
| | - Marco Rao
- Department of Drug Sciences, University of Catania, Catania, Italy
| | - Miriam Lorenti
- Department of Drug Sciences, University of Catania, Catania, Italy
| | | | - Antonio Augello
- Section of Hygiene and Food of Animal Origin (SIAOA - UFCM), Department of Veterinary Prevention, Azienda Sanitaria Provinciale (ASP - CT), Catania, Italy
| | - Chiara Maria Eandi
- Department of Ophthalmology, University of Lausanne, Hôpital Ophtalmique Jules-Gonin, Lausanne, Switzerland.,Department of Surgical Science, University of Torino, Torino, Italy
| | - Chiara Bianca Maria Platania
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy.,Center for Research in Ocular Pharmacology-CERFO, University of Catania, Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy.,Center for Research in Ocular Pharmacology-CERFO, University of Catania, Catania, Italy
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25
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Evaluation of emulsified silicone oil with spectral domain-optical coherence tomography and fluorescein angiography. Int Ophthalmol 2020; 40:2267-2274. [PMID: 32399773 DOI: 10.1007/s10792-020-01409-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND To report emulsified particles and related complications after removal of silicone oil (SO) by spectral domain-optical coherence tomography (SD-OCT) and fluorescein angiography (FA). METHODS A prospective, single-center investigation was performed using SD-OCT, FA and flare cell photometry measurements to evaluate in a cohort of eyes with emulsified silicone particles after removal of long-term SO tamponade. RESULTS Nineteen eyes of the 19 patients with emulsified silicone particles detected in ophthalmoscopic exam were included in the study: 13 (68%) were male, and 6 (31.6%) were female, and their mean age was 52.75 ± 16.06 years. Preoperative diagnoses were rhegmatogenous retinal detachment in all eyes. The mean duration of the silicone oil's presence in the eye was found as 12.63 ± 4.87 (7-26) months. SD-OCT examination postoperatively showed small, round and hyper-reflective structures compatible with emulsified silicone particles on preretinal surface in 7 (36.8%) eyes, intraretinally in 6 (31.6%) eyes and in the vitreous in 12 (63%) eyes. FA imaging demonstrated pearl-like hyper-fluorescence at early and late phases on the large blood vessels in 9 (47.4%) eyes. Late phase hyper-fluorescence due to leakage on the macula was observed in 17 (89.5%) eyes. Diffuse peripheral leakage and hyper-fluorescence was detected in 11 (57.9%) eyes. Flare levels were higher in eyes with emulsified SO compared to unaffected fellow eyes (p < 0.05). CONCLUSIONS Emulsified silicone particles that remain in the eye may lead to retinal complications and inflammation in addition to their known complications such as keratopathy and glaucoma. The particles that lead to inflammation and presence of inflammation may be examined by imaging methods such as SD-OCT and FA. Removing the SO before emulsification would be suitable for avoiding such complications.
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Romano MR, Ferrara M, Gatto C, Giurgola L, Zanoni M, Angi M, Rinaldi M, Borgia A, Sorrentino T, D'Amato Tóthová J. Safety of silicone oils as intraocular medical device: An in vitro cytotoxicity study. Exp Eye Res 2020; 194:108018. [PMID: 32209320 DOI: 10.1016/j.exer.2020.108018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/01/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
This study aimed to assess the cytotoxic effect of low molecular weight components (LMWC) and conventional silicone oils (SOs) 1000 cSt with different degree of purification (raw, intermediate, and purified) using in vitro cytotoxicity tests. Direct contact cytotoxicity tests were performed in BALB 3T3 and human retinal pigment epithelial cells (ARPE-19) using quantitative and qualitative evaluation according to the ISO 10993-5 (2009) standards. Conventional SOs 1000 cSt in form of raw, intermediate (intermediate product obtained during distillation process), and purified SO (final product after distillation) and a concentrate of LMWC (including siloxane chains with molecular weight up to 1557 g/mol) were directly applied to 100% of cell layer area for 24 h. Cell viability was quantified using 3-(4,5-dimethylthiazole-2-yl)-2,5-28 diphenyltetrazolium bromide (MTT) and neutral red uptake assays in ARPE-19 and BALB3T3, respectively. All tested samples, including the concentrate of LMWC, resulted to be not cytotoxic according to ISO 10993-5 in both qualitative and quantitative evaluations. However, the cellular viability was significantly higher in the intermediate and purified SO compared with the raw SO in ARPE-19 cells. No reduction in cell viability was detected by LMWC. The absence of cytotoxicity was observed for all tested samples in both BALB3T3 and ARPE-19 after 24 h of application. A direct cytotoxic effect is not likely to be involved in the potential complications related to SO and LMWC. Long-term potential adverse effects of SO could be related to the raw material and to different concentrations of LMWC.
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Affiliation(s)
- Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy; Eye Center, Humanitas, Via Gavazzeni 21, 24125, Bergamo, Italy.
| | | | - Claudio Gatto
- Alchilife S.R.L., Research and Development, viale Austria 14, 35020, Ponte San Nicolò, (PD), Italy
| | - Laura Giurgola
- Alchilife S.R.L., Research and Development, viale Austria 14, 35020, Ponte San Nicolò, (PD), Italy
| | - Michele Zanoni
- AL.CHI.MI.A. S.R.L., Technological Development Department, viale Austria 14, 35020, Ponte San Nicolò, (PD), Italy
| | - Martina Angi
- Ocular Oncology Service, Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, via G. Venezian 1, 20133, Milano, Italy
| | - Michele Rinaldi
- Department of Ophthalmology, Second University of Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Alfredo Borgia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy
| | - Tania Sorrentino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy
| | - Jana D'Amato Tóthová
- Alchilife S.R.L., Research and Development, viale Austria 14, 35020, Ponte San Nicolò, (PD), Italy
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Srivastava GK, Andrés-Iglesias C, Coco RM, Fernandez-Bueno I, Medina J, García-Serna J, Dueñas A, Rull F, Pastor JC. Chemical compounds causing severe acute toxicity in heavy liquids used for intraocular surgery. Regul Toxicol Pharmacol 2019; 110:104527. [PMID: 31733229 DOI: 10.1016/j.yrtph.2019.104527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 01/16/2023]
Abstract
Perfluorocarbon liquids (PFCLs) have been considered safe for intraocular manipulation of the retina, but since 2013 many cases of acute eye toxicity cousing blindness have been reported in various countries when using various commercial PFCLs. All these PFCLs were CE marked (Conformité Européenne), which meant they had been subjected to evaluation complying with the International Organization for Standardization (ISO) guidelines. These dramatic events raised questions about the safety of PFCLs and the validity of some cytotoxicity tests performed under ISO guidelines. Samples from toxic batches were analyzed by gas chromatography-mass spectrometry combined with Raman and infrared spectrometry. Perfluorooctanoic acid, dodecafluoro-1-heptanol, ethylbenzene and tributyltin bromide were identified and evaluated by a direct contact cytotoxicity test using ARPE-19 cell line, patented by our group (EP 3467118 A1). Perfluorooctanoic acid at a concentration of >0.06 mM and tributyltin bromide at a concentration of ≥0.016 mM were shown to be toxic, whereas the concentration found in the toxic samples reached 0.48 mM, and 0.111 mM, respectively. These finding emphasized the idea that determination of partially fluorinated compounds are not enough to guarantee the safety of these medical devices.
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Affiliation(s)
- Girish K Srivastava
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain; Centro en Red de Medicina Regenerativa y Terapia Celular, Junta de Castilla y León, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), OftaRed, Instituto de Salud Carlos III, Valladolid, Spain
| | - Cristina Andrés-Iglesias
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain.
| | - Rosa M Coco
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), OftaRed, Instituto de Salud Carlos III, Valladolid, Spain
| | - Ivan Fernandez-Bueno
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain; Centro en Red de Medicina Regenerativa y Terapia Celular, Junta de Castilla y León, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), OftaRed, Instituto de Salud Carlos III, Valladolid, Spain
| | - Jesús Medina
- Department of Physics of Condensed Matter, Crystallography and Mineralogy, Universidad de Valladolid, Valladolid, Spain
| | - Juan García-Serna
- High Pressure Processes Group, Instituto de Bioeconomía, Departamento de Ingeniería Química y Tecnologías del Medio Ambiente, Universidad de Valladolid, Valladolid, Spain
| | - Antonio Dueñas
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain; Toxicology Department, Universidad de Valladolid, Valladolid, Spain
| | - Fernando Rull
- Department of Physics of Condensed Matter, Crystallography and Mineralogy, Universidad de Valladolid, Valladolid, Spain
| | - J Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain; Centro en Red de Medicina Regenerativa y Terapia Celular, Junta de Castilla y León, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), OftaRed, Instituto de Salud Carlos III, Valladolid, Spain; Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Januschowski K, Szurman P, Willekens K, Bojdys MJ, Boden K. [Toxicity of heavy liquids]. Ophthalmologe 2019; 116:925-929. [PMID: 31535190 DOI: 10.1007/s00347-019-00962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute toxicity of perfluorocarbon liquids (PFCL) is a relevant problem in retinal surgery due to impurities in the medicinal product. OBJECTIVE This article gives an overview of the current problems, possible explanations, interactions with other medicinal products and approaches to improved patient safety. RESULTS Toxicity is caused by impurities in the raw material but can also be caused by interactions with other medicinal products or drugs. The current test procedures do not ideally represent the ophthalmological application but there are promising activities to set the course for the future. CONCLUSION The use of PFCL in retinal surgery is generally considered safe. Users should pay attention to the quality of medicinal products.
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Affiliation(s)
- Kai Januschowski
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland. .,Department für Augenheilkunde, Universitätsaugenklinik Tübingen, Schleichstr. 12, 72076, Tübingen, Deutschland. .,Klaus Heimann Eye Research Institute, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland.
| | - Peter Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland.,Klaus Heimann Eye Research Institute, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
| | - Koen Willekens
- Department für Augenheilkunde, Universitätsaugenklinikum Löwen, Herestraat 49, 3000, Löwen, Belgien
| | - Michael J Bojdys
- Department für Chemie, Humboldt-Universität zu Berlin, Brook-Taylor-Str. 2, 12489, Berlin, Deutschland
| | - Karl Boden
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
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Mendichi R, Schieroni AG, Piovani D, Allegrini D, Ferrara M, Romano MR. Comparative Study of Chemical Composition, Molecular and Rheological Properties of Silicone Oil Medical Devices. Transl Vis Sci Technol 2019; 8:9. [PMID: 31588374 PMCID: PMC6753963 DOI: 10.1167/tvst.8.5.9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose We evaluated chemical composition, and molecular and rheological properties in 10 commercially available silicone oils (SilOils), focusing on siloxane chains of low molecular weight (LMW components, LMWC) that are known to be “impurities” produced during the SilOil synthesis process. Methods We assessed the type of SilOil polymer and molecular weight distribution (MWD) by spectroscopy and conventional size exclusion chromatography, respectively. From the Cumulative MWD, we calculated the fractions of LMWC with molecular weight (M): ≤2000, ≤5000, and ≤10,000 g/mol. Due to the low MW, the content of LMWC with M ≤1000 g/mol was determined by gas chromatography-mass spectrometry. The dynamic viscosity (η) was assessed by rotational rheometry. Results For all SilOils, the polymer was polydimethylsiloxane. The samples differed significantly in terms of MWD and relative LMWC fractions. Specifically, the relative fraction of all LMWC (M ≤10,000 g/mol) ranged from 2.31% to 9.40% and the content of LMWC with M ≤1000 g/mol also varied significantly (range, 51–1151 ppm). The η values were different between the SilOils, and, for many of them, from the declared viscosity. Conclusions Commercially available SilOils differ significantly in molecular and rheologic features. These compounds contain a significant amount of LMWC, “impurities” generated during the synthesis process, acting as emulsifier, potentially inducing ocular inflammation and toxicity. Translational Relevance The amount of impurities in different SilOils may influence significantly their biocompatibility.
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Affiliation(s)
| | | | - Daniele Piovani
- Istituto per lo Studio delle Macromolecole (CNR), Milan, Italy
| | | | | | - Mario R Romano
- Eye Center, Humanitas, Bergamo, Italy.,Department of Biomedical Sciences, Humanitas University, Milano, Italy
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Menz DH, Feltgen N, Lechner T, Menz H, Müller BK, Dresp J, Hoerauf H. Hydrofluoric Acid and Other Impurities in Toxic Perfluorooctane Batches. Transl Vis Sci Technol 2019; 8:24. [PMID: 31171991 PMCID: PMC6543921 DOI: 10.1167/tvst.8.3.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/11/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose The complications with cytotoxic perfluorooctane (PFO) batches reported in 2015 were attributed to reactive underfluorinated impurities whose chemical identity and behavior still need to be clarified. Material and Methods We analyzed original packaged samples of Ala®octa batches involved in several reported cases of retinal toxicity. (A) The impurity profile was determined. (B) pH and fluoride ion content were measured. (C) Extraction with olive oil was performed to investigate differences in lipophilia among perfluorinated liquid (PFCL) as a measure for penetration of lipophilic cell membranes followed by measurements (A) and (B). Results (A) The detected impurities can be divided into: (1) reactive underfluorinated compounds and their degradation products including hydrogen fluoride (HF), (2) nonreactive underfluorinated compounds, (3) surface active compounds, (4) nonreactive fluorinated compounds, and (5) leachables from primary packaging components. The highest acute toxic potential is associated with the impurities of group (1). (B) HF was detected as a degradation product of reactive underfluorinated impurities by relying on the pH values and fluoride ion content of the water extracts. (C) Lipophilic impurities dissolved in PFO migrate into lipophilic extraction medium. In particular, HF is rapidly transferred in this way. Conclusions HF as degradation product of unstable or reactive underfluorinated contaminants seems of particular importance triggering the acute toxicity of affected PFO. Contamination related toxicity and unwanted side effects can only be reliably excluded via analytical controlled multistage, high-purification processes. Translational Relevance In Ala®octa batches different impurities show retinal toxicity. HF seems of particular importance of the acute toxicity of PFO.
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Affiliation(s)
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center, Goettingen, Germany
| | | | | | | | | | - Hans Hoerauf
- Department of Ophthalmology, University Medical Center, Goettingen, Germany
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31
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Gandara-Loe J, Ortuño-Lizarán I, Fernández-Sanchez L, Alió JL, Cuenca N, Vega-Estrada A, Silvestre-Albero J. Metal-Organic Frameworks as Drug Delivery Platforms for Ocular Therapeutics. ACS APPLIED MATERIALS & INTERFACES 2019; 11:1924-1931. [PMID: 30561189 DOI: 10.1021/acsami.8b20222] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Metal-organic frameworks (MOFs) have been evaluated as potential nanocarriers for intraocular incorporation of brimonidine tartrate to treat chronic glaucoma. Experimental results show that UiO-67 and MIL-100 (Fe) exhibit the highest loading capacity with values up to 50-60 wt %, whereas the performance is quite limited for MOFs with narrow cavities (below 0.8 nm, for example, UiO-66 and HKUST-1). The large loading capacity in UiO-67 is accompanied by an irreversible structural amorphization in aqueous and physiological media that promotes extended release kinetics above 12 days. Compared to the traditional drawbacks associated with the sudden release of the commercial drugs (e.g., ALPHAGAN), these results anticipate UiO-67 as a potential nanocarrier for drug delivery in intraocular therapeutics. These promising results are further supported by cytotoxicity tests using retinal photoreceptor cells (661W). Toxicity of these structures (including the metal nodes and organic ligands) for retinal cells is rather low for all samples evaluated, except for HKUST-1.
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Affiliation(s)
| | | | | | - Jorge L Alió
- Research and Development Department , VISSUM Corporation , E-03016 Alicante , Spain
| | | | - Alfredo Vega-Estrada
- Research and Development Department , VISSUM Corporation , E-03016 Alicante , Spain
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