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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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Pastor JC. Safety of perfluorocarbon liquids cannot be the retinologist's responsibility. Graefes Arch Clin Exp Ophthalmol 2021; 259:1071-1072. [PMID: 33566150 DOI: 10.1007/s00417-021-05111-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/06/2021] [Accepted: 02/04/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- J Carlos Pastor
- IOBA's Retina Group (Instituto de Oftalmobiologia Aplicada), University of Valladolid, Valladolid, Spain.
- Department of Ophthalmology, Hospital Clinico Universitario, Valladolid, Spain.
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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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Menz DH, Feltgen N, Lechner T, Menz H, Mueller BK, Dresp J, Hoerauf H. Author Response: Chemical Considerations Regarding the H-Value Methodology and Its Relation With Toxicity Determination. ACTA ACUST UNITED AC 2019; 60:3365-3367. [DOI: 10.1167/iovs.19-27341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center, Goettingen, Germany; and
| | | | | | | | | | - Hans Hoerauf
- Department of Ophthalmology, University Medical Center, Goettingen, Germany; and
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