Doi:10.1016/j.jcrs.2006.09.023

J CATARACT REFRACT SURG - VOL 33, JANUARY 2007 Interaction with intraocular lens materials: Does heavy silicone oil act like silicone oil? Aylin Yaman, MD, A. Osman Saatci, MD, Sulen Sarıog˘lu, MD, F. Hakan O PURPOSE: To determine the interaction of heavy silicone oil with various intraocular lens (IOL)materials and whether heavy silicone oil covers the silicone IOL optic as silicone oil does.
SETTING: Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey.
METHODS: The study group comprised 5 poly(methyl methacrylate) (PMMA) IOLs, 4 foldable siliconeIOLs, 5 foldable hydrophilic acrylic IOLs, and 5 foldable hydrophobic acrylic IOLs. Each IOL was bathedin balanced salt solution (BSS) for 10 minutes and then placed in heavy silicone oil dyed with SudanBlack for another 10 minutes. Afterward, each IOL was reimmersed in BSS for 5 minutes and examinedunder the light microscope. Digital images were analyzed to determine the optic area covered withheavy silicone oil.
RESULTS: The mean heavy silicone oil coverage was 7.05% G 7.88% (SD) (range 1.13% to 20.54%) onPMMA IOLs, 100% on silicone IOLs, 12.17% G 11.43% (range 1.25% to 31.52%) on hydrophobic acrylicIOLs, and 34.64% G 13.28% (range 12.57% to 44.42%) on hydrophilic acrylic IOLs. Heavy silicone oilcoverage of silicone IOLs was statistically significantly greater than the coverage of other IOL materials.
CONCLUSION: Heavy silicone oil acted the same as silicone oil and covered the entire surface ofsilicone IOLs.
J Cataract Refract Surg 2007; 33:127–129 Q 2007 ASCRS and ESCRS The compatability of various intraocular lens (IOL) mate- We tested the interaction of heavy silicone oil with var- rials and silicone oil has been investiIt is well- ious IOL materials to determine whether the IOL interac- established that silicone oil manifests as a thick coating tion with heavy silicone oil differs from the interaction with droplet formation on the silicone IOL surface and adheres to the surface so tenaciously that it cannot beremoved by instruments or injection of ophthalmic visco- surgical devices (OVDs).The mean silicone oil coverageof silicone IOL optics varies between and 100%.
Four IOL materials were tested in vitro to evaluate the adherence of heavy silicone oil to the IOL optic: Single-piece rigid The viscosity of the oil does not affect the adherence.
poly(methyl methacrylate) (PMMA) (Crystal Type 1, Alcon Labo- Proliferative vitreoretinopathy has a propensity for the ratories) (n Z 5); 3-piece foldable silicone (Oculaid PC 420Y, inferior retina. Recently, silicone oil types heavier than wa- Ophtec Laboratories) (n Z 4); monoblock foldable hydrophilic ter were introduced in eyes with complicated inferior reti- acrylic (Auroflex FH 5575, Aurolab) (n Z 5); and monoblock nal detachment having vitreoretinal surgeryHeavy foldable hydrophobic acrylic (AcrySof SA30AL, Alcon Laborato-ries) (n Z 5). A total of 19 IOLs were tested.
silicone oil alleviates the need for a face-down position The method to visualize the adherence of heavy silicone oil postoperatively and effectively tamponades inferior breaks.
(Oxane HD, Bausch & Lomb) to the IOL optic was modifiedfrom O ¨ ner et and McLoone et The heavy silicone oil was dyed using Sudan Black for better visualization of the heavysilicone oil droplets covering the IOL optic. In a test tube, Accepted for publication September 1, 2006.
20 mg/mL of the dye was mixed with 1.0 mL of heavy silicone From the Department of Ophthalmology, Dokuz Eylul University, oil and the mixture was centrifuged at 10 000 cycles/min for 15 minutes to separate excessive dye from the heavy silicone oil.
Each IOL was immersed first in balanced salt solution (BSS) for No author has a proprietary or financial interest in any material or 10 minutes and then in the dyed heavy silicone oil for 10 minutes.
The IOL was reimmersed in BSS for another 5 minutes and then Corresponding author: Aylin Yaman, MD, Koruturk Mah. Nar Sok, examined under light microscopy (Olympus BX51, Olympus No: 17/2, Balcova, Izmir, 35335, Turkey.
Optical Co. Ltd.). Digital images were taken using a 3CCD color LABORATORY SCIENCE: SILICONE OIL–IOL MATERIAL INTERACTION Table 1. Percentage of heavy silicone oil coverage of each IOL and mean coverage of IOL types.
IOL Z intraocular lens; PMMA Z poly(methyl methacrylate) video camera (Olympus DP70, Olympus Optical Co. Ltd.) characteristics of IOLs with several dyes (indocyanine connected to a light microscope at an original magnification of Â1.25. The system was connected to a computer (Vestel), Vitreoretinal surgeons continue to look for tamponade and image analysis was performed (BS 200D Image Analysis Soft-ware, BAB Imaging Systems Ltd.).
agents with a high specific gravity to provide a safe and ef- The area of heavy silicone oil droplets covering the IOL op- ficient long-term inferior tamponade. Two recently intro- tic was measured in pixels with the image analysis system, using duced commercial substances are Oxane HD (Bausch & an interactive area-measurement method. The ratio of heavy sil- icone oil covering the optic to the total optic area was deter- (heavy silicone oil) is a mixture of silicone oil (Oxane mined as the percentage of heavy silicone coverage. The datawere analyzed using Kruskal-Wallis and Mann-Whitney U tests 5700, Bausch & Lomb) and a mixed fluorinated and hydro- carbonated olefin (RMN3).The density is 1.03 g/cm3, therefractive index is 1.40, and the viscosity is 3800 cSt.
Densiron-68 is a solution of perfluorohexyloctane and5000 cSt silicone oil. The specific gravity is 1.06 g/cm3 The mean percentage of heavy silicone oil coverage of each IOL and the mean heavy silicone coverage of each IOL To our knowledge, there is no clinical report or exper- material group are shown in . The percentage of imental study of the interaction of heavy silicone oil and heavy silicone oil coverage was compared among the IOL IOLs. Perhaps this is because most surgeons assume that materials (Statistical comparison showed that heavy silicone oil will behave the same as silicone oil heavy silicone oil coverage of silicone IOLs was signifi- when it interacts with silicone IOLs. Wolf et evaluated cantly greater than the coverage of the other IOL materials.
the efficacy and safety of heavy silicone oil in eyes withcomplicated retinal detachments involving the inferior part of the retina and excluded pseudophakic eyes with sil- Currently, surgical techniques are become increasingly sophisticated and surgical adjuncts are diversified. Anterior Our study clearly showed that heavy silicone oil be- and posterior segment surgeries are becoming intermingled haved the same as silicone oil and adhered strongly to sili- to some degree. The compatibility and interaction of new cone IOLs, completely covering the surfaces. The mean surgical agents with IOL materials are of interest, but some- heavy silicone oil coverage of silicone IOLs was 100%.
times cause confusion. We previously analyzed the interac- The least adherence was observed in the group of PMMA tion of IOLs with various viscosities of silicone oil and IOLs, where the the mean heavy silicone oil coverage was triamcinolone acetonide and looked at the staining Table 2. Results of statistical analysis.
IOL Z intraocular lens; PMMA Z poly(methyl methacrylate)*Statistically significant J CATARACT REFRACT SURG - VOL 33, JANUARY 2007 LABORATORY SCIENCE: SILICONE OIL–IOL MATERIAL INTERACTION As a result of our study, we recommend that silicone rasterelektronenmikroskopische Untersuchung study. Klin Monatsbl IOLs not be used in patients with current vitreoretinal dis- ¨ ner FH, Saatci OA, Sarıog˘lu S, et al. Interaction of intraocular lenses ease or those who are at high risk for future vitreoretinal with various concentrations of silicone oil: an experimental study.
disease (ie, diabetic or highly myopic patients) and may require silicone oil or heavy silicone oil injection.
6. Bhisitkul RB, Gonzalez VH. ‘‘Heavy oil’’ for intraocular tamponade in retinal detachment surgery [editorial]. Br J Ophthalmol 2005;89:649–650 7. McLoone E, Mahon G, Archer D, Best R. Silicone oil-intraocular lens interaction: which lens to use? Br J Ophthalmol 2001; 85:543–545 1. Apple DJ, Federman JL, Krolicki TJ, et al. Irreversible silicone oil 8. Arikan G, Saatci AO, Sarioglu S. Adherence of triamcinolone acetonide adhesion to silicone intraocular lenses; a clinicopathological analysis.
to various intraocular lens materials. J Cataract Refract Surg 2005; Ophthalmology 1996; 103:1555–1561; discussion by TM Aaberg Sr, 9. Ozbek Z, Saatci AO, Durak I, et al. Staining of intraocular lenses with 2. Apple DJ, Isaacs RT, Kent DG, et al. Silicone oil adhesion to intraocular various dyes: a study of digital image analysis. Ophthalmologica lenses: an experimental study comparing various biomaterials. J Cat- 10. Wolf S, Scho¨n V, Meier P, Wiedermann P. Silicone oil–RMN3 mixture 3. Senn P, Schmid MK, Schipper I, Hendrickson P. Interaction between sil- (‘‘heavy silicone oil’’) as internal tamponade for complicated retinal icone oil and silicone intraocular lenses: an in vitro study. Ophthalmic 11. Wong D, Van Meurs JC, Stappler T, et al. A pilot study on the use of a perfluorohexyloctane/silicone oil solution as a heavier than water Silikono¨l mit verschiedenen Intraokularlinsen; Eine licht- und internal tamponade agent. Br J Ophthalmol 2005; 89:662–665 J CATARACT REFRACT SURG - VOL 33, JANUARY 2007

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