A Novel High-Density Silicone Oil (Densiron Xtra) as a Tamponade for Retinal Detachments: A Canadian Series
Authors: Rajinder S. Nirwan, Natalia Figueiredo, Julia Farah, Shellina Kherani, Sarah Ha, April Ingram, Geoff Williams, Amin Kherani.
Author Disclosure Block: R.S. Nirwan: None. N. Figueiredo: None. J. Farah: None. S. Kherani: None. S. Ha: None. A. Ingram: None. G. Williams: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Bayer, Novartis, Roche. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Bayer, Novartis, Roche, Chengdu Kanghong. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Name of for-profit or not-for-profit organization(s); Arctic Dx. A. Kherani: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Novartis, Roche, Bayer, Alcon. Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Abbvie, Alcon, Bayer, Bausch and Lomb, Novartis. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Abbvie, Allergan, Alcon, Bayer, Novartis, Roche, Genetech, Opthotech, Chengdu Kanghong, Biotechnology, Regeneron. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Name of for-profit or not-for-profit organization(s); MD Collaborate.
Purpose: Inferior retinal detachments (RDs) may be accompanied with numerous complexities including post-operative positioning, recurrence, and predilection for proliferative vitreoretinopathy. Although high-density silicone oils (heavier-than-water) are ideal endotamponades for the aforementioned scenario, they have been documented to emulsify leading to potential complications. Densiron® Xtra is a novel heavy silicone oil (HSO) that has not been studied in a clinical setting to the best of our knowledge. The purpose of our study is to assess the efficacy and safety of the novel HSO in the management of RDs.
Study Design: A non-comparative, retrospective chart review of patients aged 18 to 90 years of age that underwent treatment of RD with the novel HSO agent at a single site (Calgary Retina Consultants) from April 2017 to May 2020. Methods: Seventy-four eyes or 74 patients (50 male, 24 female) were included. Standard 3-port pars plana vitrectomy (PPV) was performed in all patients. Three patients required cryotherapy, 21 required a scleral buckle (SB), 71 required the use of perfluoro-N-octane (PFO), 29 patients required peeling, and 18 patients underwent retinectomy. The primary outcome was anatomical success (retinal reattachment) at time of oil removal and 6 months post-oil removal. Secondary outcomes were visual acuity (VA) at 6 months post-oil removal and complications including emulsification.
Results: The mean age at presentation was 62y (SD 17). Fifty patients previously underwent an intraocular procedure for RD. There were 14 macula-on, nine macula-split, and 51 macula-off RDs. Silicone oil was removed in 64 of 74 (86.5%) eyes with average duration of 18 weeks of tamponade (95% CI: 15-21). At time of oil removal, 50 eyes (78.1%) remained anatomically attached, while 14 eyes (21.9%) re-detached. Of the 14 eyes that re-detached, four required additional surgery within 6 months of oil removal for recurrent detachments. Average follow-up time was 16 months. Reviewing visual acuity, 66% demonstrated improvement, 14% experienced a decline, and 20% had no change in vision. Intraocular pressure elevation (> 25 mm Hg) requiring treatment was noted in 27 eyes (36.5%), with 15 needing prolonged treatment. There were zero cases of emulsification. Of the 58 patients with 6 months post-oil removal data, 43 (74.1%) were successfully reattached with one surgery with HSO.
Conclusions: The novel HSO is a safe and effective heavy-silicone oil for the use of retinal detachments, particularly inferior detachments. There were zero cases of emulsification identified. The retinal re-attachment rate at time of oil removal was 78.1%, with a 74.1% rate of successful anatomic reattachment at 6 months post-oil removal.