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作者：王少華 黃振平
【摘要】氟碳液體自1987年Stanley Chang首次在玻璃體視網(wǎng)膜手術(shù)中應(yīng)用已20a，氟碳液體在玻璃體視網(wǎng)膜手術(shù)中的作用相當(dāng)于粘彈劑在眼前段手術(shù)中的作用。20a來，氟碳液體在玻璃體視網(wǎng)膜手術(shù)中的應(yīng)用范圍不斷擴(kuò)大，對氟碳液體的基礎(chǔ)研究也沒有停止，現(xiàn)就氟碳液體在眼科的實(shí)驗(yàn)研究和臨床應(yīng)用作一綜述。
【關(guān)鍵詞】 氟碳液體 眼科學(xué)
The experimental research and clinic application of perfluorocarbon liquids in ophthalmology
AbstractSince perfluorocarbon liquids was applied in vitreoretinal surgery for the first time by Stanley Chang in 1987, its function in vitreoretinal surgery is the same as viscoelastic in anterior segment surgery. In the 20 years, perfluorocarbon liquids have been used in surgery for a wide variety of vitreoretinal disorder, and the related experimental researches have not been terminated. The present paper reviews the experimental researches and clinic applications of perfluorocarbon liquids in ophthalmology.
· KEYWORDS: perfluorocarbon liquids; ophthalmology
0引言
氟碳液體(Perfluorocarbon liquid)是有機(jī)烴中的氫被氟取代的一組化合物，一般有6個(gè)以上碳原子，也可含氧、氮、硫原子，可以通過多種方法合成[1]。無色透明，高比重，低粘度，不溶于水，生物化學(xué)性質(zhì)穩(wěn)定，無毒性，其優(yōu)良的氧和二氧化碳溶解度，可以用來制造人造血液[2]。自1987年 Chang[3]首次在眼科玻璃體視網(wǎng)膜手術(shù)中作為流體動(dòng)力操作工具(Hydrokinetic manipulation tool)應(yīng)用已經(jīng)近20a。本文就氟碳液體在眼科的實(shí)驗(yàn)研究和臨床應(yīng)用作一回顧性綜述。
1氟碳液體眼科實(shí)驗(yàn)研究
1982年Haidt 等[4]首次將氟碳液體注入動(dòng)物眼內(nèi)，觀察到氟碳液體在動(dòng)物眼內(nèi)有魚卵樣(fish egg appearance )變化。以后用作眼科應(yīng)用實(shí)驗(yàn)研究的氟碳液體有氟化多醚(Perfluoroether)[5],全氟三丁胺(Perfluorotributylamine)[6],全氟菲(Perfluorophenanthrene)[7],全氟辛烷(Perfluorooctane)[8],全氟萘烷(Perfluorodecalin)[9,10],全氟乙基環(huán)己烷(perfluoroethylcyclohexane)[11],全氟三正丙烷(Perfluorotri-n-propylamine)等[12,13]。氟碳液體注入眼內(nèi)對視網(wǎng)膜的影響主要表現(xiàn)為下方與氟碳液體接觸的視網(wǎng)膜外叢狀層變窄，感光細(xì)胞核減少，感光細(xì)胞外節(jié)損害。氟碳液體注入視網(wǎng)膜下[14]會(huì)引起視網(wǎng)膜內(nèi)外核層的水腫，外節(jié)段變性，亦可以發(fā)現(xiàn)氟碳液體被吞噬現(xiàn)象。氟碳液體在前房內(nèi)可以引起下方與氟碳液體接觸的角膜內(nèi)皮細(xì)胞缺失與水腫。Versura 等[15]用免疫組化的方法檢查了全氟萘烷玻璃體替代的組織學(xué)結(jié)果，在不同眼組織基質(zhì)、氟碳液體泡周圍發(fā)現(xiàn)了免疫球蛋白和補(bǔ)體片斷，提示有免疫反應(yīng)發(fā)生。資料顯示氟碳液體在眼內(nèi)存留，對視網(wǎng)膜的影響不僅與氟碳液體的純度有關(guān)，還與氟碳液體的原子構(gòu)成有關(guān)，僅含氟、碳原子的氟碳液體要比含氧、氮原子的氟碳液體眼內(nèi)耐受性好。也有文獻(xiàn)[16]認(rèn)為氟碳液體對視網(wǎng)膜的影響僅是其比重2倍于水的重力物理作用。玻璃體腔內(nèi)注入氟碳液體后ERG的變化認(rèn)為是氟碳液體的絕緣作用，氟碳液體取出后波形會(huì)逐漸恢復(fù)。新的研究提出了氟碳液體引起視網(wǎng)膜變化的新假設(shè)[17]：氟碳液體阻止Müller細(xì)胞的內(nèi)終足將視網(wǎng)膜內(nèi)的鉀離子虹吸到玻璃體腔，視網(wǎng)膜外層鉀離子增加，引起神經(jīng)組織變性和反應(yīng)性膠質(zhì)增生。
1.1氟碳液體對培養(yǎng)纖維細(xì)胞的影響[18] 為觀察氟碳液體的生物化學(xué)穩(wěn)定性，我們將纖維細(xì)胞種植于氟碳液體與培養(yǎng)基的界面，觀察纖維細(xì)胞的生長情況，含沒有完全氟化的氫的氟碳液體，纖維細(xì)胞有附著生長、增殖活躍，氧化鋁處理氟碳液體，可以去除氟碳液體中含氫雜質(zhì)(未完全氟化物質(zhì))，減少纖維細(xì)胞生長增殖。
1.2氟碳液體對血視網(wǎng)膜屏障的影響[19] 兔眼玻璃體腔內(nèi)注入全氟辛烷0.3mL，兔靜脈注射熒光素，熒光光度計(jì)測量前房，玻璃體熒光含量，觀察氟碳液體對血視網(wǎng)膜屏障的影響，結(jié)果術(shù)后第1d前房熒光含量與對照有顯著差異，術(shù)后第7d玻璃體熒光含量與對照有顯著差異，長期研究(7wk)沒有發(fā)現(xiàn)血視網(wǎng)膜屏障滲透性增加。
1.3氟碳液體玻璃體替代后的氧動(dòng)力學(xué)研究[20,21] 氟碳液體中的CF3的自旋晶格釋放時(shí)間是其氧分壓的敏感快速指標(biāo)，兔眼玻璃體腔充滿全氟三丁胺后動(dòng)物吸入950mL/L氧氣，50mL/L二氧化碳，19F核磁共振光譜儀測定氟碳液體中氧分壓變化，氟碳液體氧攝入與時(shí)間常數(shù)是一條簡單指數(shù)曲線159±110min(mean±SD,n =3)。動(dòng)物改吸空氣，氟碳液體中氧清除與時(shí)間常數(shù)也是一條簡單指數(shù)曲線59.8±9.6min(mean±SD,n =4)。氟碳液體注入玻璃體腔以前純氧灌注，注入兔玻璃體腔后動(dòng)物吸入空氣，氧分壓變化與時(shí)間常數(shù)也是一條簡單指數(shù)曲線69.6±12.6min(mean±SD, n =4)。臨床上氟碳液體在手術(shù)后存留位于視網(wǎng)膜表面，19F磁共振光譜儀測定氟碳液體內(nèi)氧分壓代表視網(wǎng)膜表面的氧分壓，可以用來檢測糖尿病視網(wǎng)膜病變，早產(chǎn)兒視網(wǎng)膜病變等疾病視網(wǎng)膜內(nèi)層的氧分壓。
1.4氟碳液體與硅油的聯(lián)合應(yīng)用[22-27] 早期認(rèn)為氟碳液體不溶于硅油，利用兩者不同的比重，兩者聯(lián)合應(yīng)用注入玻璃體腔可以分別對下方和上方的視網(wǎng)膜起頂壓作用(1mL硅油向上的作用力是0.06g,0.3mL氟碳液體向下的作用力是0.25g)，動(dòng)物實(shí)驗(yàn)氟碳液體和硅油聯(lián)合應(yīng)用注入玻璃體腔可以阻止玻璃體切除后玻璃體腔注入成纖維細(xì)胞誘導(dǎo)的視網(wǎng)膜脫離。臨床上也成功應(yīng)用，在氟碳液體和硅油注入玻璃體腔數(shù)周后兩者之間的液平清晰。以后有人報(bào)道在臨床視網(wǎng)膜復(fù)位手術(shù)過程中使用氟碳液體后硅油填充的病例取硅油時(shí)有“重”硅油沉在下方難以取出，因?yàn)檫@種物質(zhì)既不象硅油自動(dòng)上浮，也不象氟碳液體那樣粘度低容易吸出，經(jīng)檢驗(yàn)是殘余氟碳液體與硅油、水的混合物，體外實(shí)驗(yàn)證實(shí)硅油不溶于氟碳液體，但相當(dāng)量氟碳液體可溶于硅油。硅油的粘度不影響氟碳液體溶解度。
1.5氟碳液體細(xì)菌培養(yǎng) 氟碳液體在眼科玻璃體視網(wǎng)膜手術(shù)中的廣泛應(yīng)用是否會(huì)增加細(xì)菌污染和感染的機(jī)會(huì)，Moreira等[28]將金葡菌和銅綠假單胞菌接種于全氟辛烷，生理鹽水，37℃孵育箱保存，接種后0、72、168、240h分別取接種樣本平板細(xì)菌培養(yǎng)24h，計(jì)算細(xì)菌克隆，結(jié)果金葡菌和銅綠假單胞菌無法在全氟辛烷中生長， 我們認(rèn)為不能單以氟碳液體中缺乏營養(yǎng)來解釋，因?yàn)榧?xì)菌在生理鹽水中生長良好。氟碳液體在玻璃體視網(wǎng)膜手術(shù)中不易被細(xì)菌污染，不增加感染機(jī)會(huì)。
1.6氟碳液體對凝血的影響 Moreira 等[29]研究了氟碳液體在體外，體內(nèi)對凝血的影響。健康志愿者血標(biāo)本加入一定量氟碳液體，測定凝血時(shí)間，部分促凝血酶原激酶時(shí)間(內(nèi)源凝血通路)，一期凝血酶原時(shí)間(外源性凝血系統(tǒng))，結(jié)果與對照無顯著差異。體內(nèi)實(shí)驗(yàn)，Moreira 比較了玻璃體切除后視網(wǎng)膜大動(dòng)脈出血注入氟碳液體和林格氏液，在相同灌注壓高度下，前者止血時(shí)間較后者短，兩者有顯著差異。我們認(rèn)為氟碳液體在玻璃體腔內(nèi)有很好的止血作用，特別是當(dāng)出血來源多無法確定時(shí)。但氟碳液體促進(jìn)止血的機(jī)制并不清楚。
2氟碳液體的眼科臨床應(yīng)用
2.1嚴(yán)重PVR視網(wǎng)膜脫離[30,31] 氟碳液體最早用于一般玻璃體切除，剝膜也無法復(fù)位的嚴(yán)重PVR視網(wǎng)膜脫離，玻璃體切除后，注入氟碳液體，其高比重將視網(wǎng)膜壓平，視網(wǎng)膜下液體從原有前部裂孔溢出無須在后極部作視網(wǎng)膜切開，氟碳液體使視網(wǎng)膜相對固定，更有利于視網(wǎng)膜前剝膜。視網(wǎng)膜收縮粘連嚴(yán)重的病例，估計(jì)氟碳液體也不能將視網(wǎng)膜壓平，可先注入少量氟碳液體固定視網(wǎng)膜后極部，再作剝膜，視網(wǎng)膜切開，切除，再注入氟碳液體壓平視網(wǎng)膜，做視網(wǎng)膜光凝，鞏膜冷凝，外加壓環(huán)扎，置換眼內(nèi)填充。
2.2巨大裂孔視網(wǎng)膜脫離[32,33] 巨大裂孔視網(wǎng)膜脫離在玻璃體切除剝膜后注入氟碳液體，翻轉(zhuǎn)的視網(wǎng)膜瓣會(huì)充分復(fù)位，視網(wǎng)膜與色素上皮緊貼，裂孔常閉合成一細(xì)溝，直接眼內(nèi)光凝或鞏膜外冷凝的位置精確，效果更好，冷凝產(chǎn)生的色素上皮細(xì)胞播散少，如PVR不嚴(yán)重，可以不做鞏膜環(huán)扎，在氣液交換時(shí)放慢速度，可以防止視網(wǎng)膜瓣向后滑動(dòng)，可以置換眼內(nèi)填充，也可以將氟碳液體留在眼內(nèi)，待視網(wǎng)膜與色素上皮粘連，適當(dāng)時(shí)再置換眼內(nèi)填充。
2.3脫位晶狀體、人工晶狀體[34,35] 玻璃體切除后，充分游離脫位晶狀體，人工晶狀體，注入氟碳液體，其高比重可以將晶狀體浮至玻璃體中央超聲粉碎或切割，可以將人工晶狀體上浮至后房，重新固定或取出、置換，避免眼內(nèi)反復(fù)操作，晶狀體、人工晶狀體掉落對視網(wǎng)膜的損傷，如有視網(wǎng)膜脫離可同時(shí)處理。
2.4玻璃體積血視網(wǎng)膜脫離[36,37] 玻璃體積血病例待玻璃體后脫離是減少玻璃體切割并發(fā)癥的重要條件，氟碳液體在玻璃體積血手術(shù)中不與血液混合，手術(shù)視野清晰，在積血的玻璃體和視網(wǎng)膜之間形成一保護(hù)屏障，對于沒有玻璃體后脫離的病例可以在玻璃體后界膜作小孔后注入氟碳液體分離玻璃體后界膜與視網(wǎng)膜，減少視網(wǎng)膜并發(fā)癥。
2.5脈絡(luò)膜上腔出血[38,39] 脈絡(luò)膜上腔出血如沒有眼內(nèi)容脫出可以手術(shù)治療，氟碳液體改善了這些患者的預(yù)后。360度剪開球結(jié)膜，角膜緣后4mm，3個(gè)象限做平行角膜緣3mm鞏膜切開，從顳下象限(無晶狀體眼從角鞏緣，有晶狀體從睫狀體平坦部)刺入30號細(xì)長針至玻璃體腔看到針尖，緩慢注入氟碳液體，用棉簽輕壓眼球使脈絡(luò)膜上腔出血從鞏膜切口中溢出，除去脈絡(luò)膜上腔出血后，再做玻璃體切除。
2.6黃斑裂孔視網(wǎng)膜脫離[40-42] 黃斑裂孔視網(wǎng)膜脫離在引流視網(wǎng)膜下液體后注入氟碳液體，再作內(nèi)界膜剝離，由于有氟碳液體的重力對抗作用，視網(wǎng)膜比較穩(wěn)定，剝膜操作似比原來容易，在剝離內(nèi)界膜時(shí)如使用吲哚青綠染色，少量氟碳液體除可以壓平視網(wǎng)膜還可以防止吲哚青綠進(jìn)入視網(wǎng)膜下。
2.7早產(chǎn)兒視網(wǎng)膜病變[43] 嚴(yán)重的早產(chǎn)兒視網(wǎng)膜病變手術(shù)很困難。二通道玻璃體切割，鞏膜切口作在虹膜根部后面，玻璃體切割器械直接插入晶狀體，在晶狀體囊內(nèi)吸除晶狀體皮質(zhì)和核，晶狀體前囊保留到最后切除。后囊與濃縮的前部玻璃體如用玻璃體切割器抓不牢，或是閉漏斗，可以用玻璃體剪剪開，23號長針注入氟碳液體2mL在視網(wǎng)膜前面，后部視網(wǎng)膜被壓平，前部再用玻璃體剪作放射切開，避開視網(wǎng)膜和新生血管，空間擴(kuò)大后可進(jìn)一步注入氟碳液體，視網(wǎng)膜下液體可以從作在角膜緣后6mm的鞏膜切口排出。即使撤掉灌注光纖，氟碳液體仍維持眼球形狀，視網(wǎng)膜足夠平后，更換眼內(nèi)填充。關(guān)閉鞏膜切口后，赤道部作鞏膜環(huán)扎，前部新生血管組織予冷凝。
2.8化膿性眼內(nèi)炎[44] 化膿性眼內(nèi)炎玻璃體腔充滿致密膿性團(tuán)塊，與視網(wǎng)膜粘連很緊，玻璃體切除時(shí)很容易傷及視網(wǎng)膜。為了使玻璃體切除容易些，預(yù)先注入少量氟碳液體沉至——能支撐氟碳液體的平面，可以是停留在炎性膜表面，也可能直接到達(dá)視網(wǎng)膜，玻璃體切除時(shí)仔細(xì)分辨，如是炎性膜則繼續(xù)切除，氟碳液體再下沉，直至視網(wǎng)膜。氟碳液體有利于整個(gè)切除過程中對視網(wǎng)膜的保護(hù)。
2.9與t-PA聯(lián)合應(yīng)用治療黃斑下出血[45] 老年性黃斑變性黃斑出血，在玻璃體切除后，黃斑下積血可以用t-PA液化，再用氟碳液體將積血擠入玻璃體腔后吸除。
2.10其他 氟碳液體在嚴(yán)重增殖性糖尿病視網(wǎng)膜病變[46]，脈絡(luò)膜缺損視網(wǎng)膜脫離[47]，視網(wǎng)膜多發(fā)裂孔[48]，視網(wǎng)膜劈裂[49]，眼球內(nèi)異物[50]，中心漿液性視網(wǎng)膜脈絡(luò)膜病變引起的大泡性視網(wǎng)膜脫離[51]，人工角膜視網(wǎng)膜脫離[52]，脈絡(luò)膜腫瘤切除[53]，去除視網(wǎng)膜下氣體[54]，黃斑轉(zhuǎn)位[55]等手術(shù)中也有成功應(yīng)用。
2.11氟碳液體在眼內(nèi)的B超，CT，MRI圖像[56-58] 氟碳液體在手術(shù)后可以存留眼內(nèi)，B超圖像顯示氟碳液體位于眼球最低位置，氟碳液體內(nèi)部為一無回聲區(qū)，表面為回聲增強(qiáng)線，氟碳液體后有一串類似金屬異物的偽像。氟碳液體在CT中顯示不透光影，可以顯示氟碳在眼內(nèi)的分布。氟碳液體在眼內(nèi)MRI檢查T1W,T2W顯示顯著低信號，無法評價(jià)視網(wǎng)膜。
2.12氟碳液體臨床應(yīng)用選擇，眼內(nèi)保留時(shí)間及并發(fā)癥 動(dòng)物實(shí)驗(yàn)已證實(shí)僅含氟碳原子的氟碳液體如全氟菲(Perfluorophenanthrene)比含氧氮原子的氟碳液體如全氟三丁胺(Perfluorotributylamine)眼內(nèi)耐受好，選擇毫無疑義。有文獻(xiàn)比較了臨床常用的全氟辛烷(Perfluorooctane)與脫氫全氟菲[59,60](Perfluoroperhydrophenanthrene)臨床應(yīng)用結(jié)果，全氟辛烷屈光指數(shù)1.27，蒸發(fā)壓52mmHg,粘度0.69centistoke,脫氫全氟菲屈光指數(shù)1.33(與生理鹽水和房水極近似)，蒸發(fā)壓<1mmHg,粘度8.3centistoke,全氟辛烷與生理鹽水的屈光指數(shù)區(qū)別、高蒸發(fā)壓、低粘度使其在臨床手術(shù)過程中更容易取干凈。術(shù)后角膜異常，眼壓升高的發(fā)生率比脫氫全氟菲低，但兩者應(yīng)用后視網(wǎng)膜復(fù)位率無顯著差異。為提高脫氫全氟菲的表面能見度，Liang等[61]將全氟辛烷與全氟脫氫菲按不同比例混合，改變屈光指數(shù)后使用。術(shù)中使用氟碳液體并發(fā)癥主要為氟碳液體進(jìn)入視網(wǎng)膜下，大多數(shù)文獻(xiàn)認(rèn)為后極部大裂孔不能使用氟碳液體，全氟菲18dynes/cm的表面張力可以阻止其從小于0.5視盤直徑的裂孔進(jìn)入視網(wǎng)膜下[37,62-64]，Han 等[65]報(bào)道，在視網(wǎng)膜切除，切開后只要解除所有的視網(wǎng)膜牽引，氟碳液體注入可以超過視網(wǎng)膜切開的后緣，19例患者只有1例發(fā)生氟碳液體進(jìn)入視網(wǎng)膜下。一旦氟碳液體進(jìn)入視網(wǎng)膜下，除從原視網(wǎng)膜裂孔吸除外還可以作后極部視網(wǎng)膜切開引流。文獻(xiàn)報(bào)道視網(wǎng)膜下殘留的氟碳液體[66-69]可以用39號彈性管道在氟碳液體旁切開，將管道伸入氟碳液體泡內(nèi)吸除，術(shù)后視力得到提高。文獻(xiàn)均認(rèn)為氟碳液體在眼內(nèi)保留一段時(shí)間可引起視網(wǎng)膜，角膜內(nèi)皮損害，仍有將氟碳液體在手術(shù)后留在眼內(nèi)作眼內(nèi)填充，待視網(wǎng)膜與色素上皮形成粘連。Tanji等[70]報(bào)道將脫氫全氟菲在患者眼內(nèi)保留了3d～9wk(平均3.3wk)，Blinder 等[71]將全氟菲在患者眼內(nèi)保留了5d～4wk，術(shù)后保持坐位或仰臥位，取得滿意臨床效果。并發(fā)癥為白內(nèi)障，視網(wǎng)膜脫離復(fù)發(fā),PVR復(fù)發(fā)，低眼壓，黃斑皺折，高眼壓，前房滲出，發(fā)生率與其他玻璃體手術(shù)硅油填充后相似。有個(gè)案報(bào)道[72]殘留氟碳液體在眼內(nèi)可引起巨細(xì)胞炎癥反應(yīng)。
3小結(jié)
重水(氟碳液體)以它特殊的物理、化學(xué)特點(diǎn)，作為流體動(dòng)力操作工具(hydrokinetic manipulation tool)在玻璃體視網(wǎng)膜手術(shù)中應(yīng)用，極大的方便了玻璃體視網(wǎng)膜手術(shù)，提高手術(shù)成功率。臨床效果得到時(shí)間的檢驗(yàn)，甚至有文獻(xiàn)[73]建議玻璃體切割時(shí)用氟碳液體作灌注液。但氟碳液體作為玻璃體替代物不能像硅油那樣在玻璃體腔內(nèi)長期保留。
【參考文獻(xiàn)】
1 Dale B. Fluorocarbons: Properties and Syntheses. Federat Proceed ,1975;34:1444-1448
2 Maugh H. Perfluorochemical emulsion: Promising blood substitute. Science ,1973;179:669
3 Chang S. Low viscosity liquid fluorochemicals in vitreous surgery. Am J Ophthalmol ,1987;103(1):38-43
4 Haidt SJ, Clark LC Jr, Ginsberg J. Liquid perfluorocarbon replacement of the eye. Invest Ophthalmol Vis Sci ,1982:22(ARVO Supple):242
5 Miyamoto K, Refojo MF,Tolentino FI, Fournier GA ,Albert DM. Perfluoroether liquid as a long term vitreous substitute. Retina ,1984;4(4):264-268
6 Chang S, Zimmerman NJ, Iwamoto T ,Ortiz R,Faris D. Experimental vitreous replacement with Perfluorotributylamine. Am J Ophthalmol ,1987;103(1):29-37
7 Stolba U, Krepler K, Pflug R ,Velikay M,Wedrich A,Binder S. Experimental vitreous and aqueous replacement with perfluorophenanthrene. Retina ,1997;17(2):146-153
8 Eckardt C,Nicolai U,Winter M ,Knop E..Experimental intraocular tolerance to liquid perfluorooctane and perfluoropolyether. Retina ,1991;11(4):375-384
9 Versura P, Cellini M, Torreggiani A, Bernabini. B, Rosso A, Moretti M, Carammzza R. The biocompatibility of silicone,fluorosilicone and perfluorocarbon liquids as vitreous tamponades. Ophthalmology ,2001;215(4):276-283
10 Mertens S,Bednarz J,Richard G Engelnann K. Effect of perfluorodecalin on human retinal pigment epithelium and human corneal endothelium in vitro . Graefes Arch Clin Exp Ophthalmol ,2000;238(2):181-185
11 Sparrow JR, Matthews P, Iwamoto T, Ross R, Gershbein A, Chang S. Retinal tolerance to intravitreal perfluoroethylcyclohexane liquid in the rabbit. Retina ,1993;13(1):56-62
12 Bryan S, Friedman SM, Mames RN, Margo CE. Experimental vitreous replacement with perfluorotri-n-propylamine. Arch Ophthalmol ,1994;112(8):1098-1102
13 Peyman GA, Soheilian M, Luo Q, Moshfeghi D, Schweighardt FK. Intravitreal tolerance of a new perfluorocarbon vitreous replacement. Can J Ophthalmol ,1996;31(7):345-349
14 De Queiroz JM. Subretinal perfluorocarbon liquids: An experimental study. Retina ,1992;12(suppl):33-39
15 Versura P, Cellini M, Torreggiani A, Bernabini B, Rossi A, Moretti M, Caramazza R. The biocompatibility of silicone,fluorosilicone,and perfluorocarbon liquid as vitreous tamponades:An ultrastructural and immunohistochemical study. Ophthalmolgy ,2001;215(4):276-283
16 Stolba U, Krepler K, Velikay-Parel M, Binder S. The effect of specific gravity of perfluorocarbon liquid on the retina after experimental vitreous substitution. Graefes Arch Clin Exp Ophthalmol ,2004;242(11):931-936
17 Winter M, Eberhardt W, Scholz C, Reichenbach A. Failure of potassium siphoning by Muller cells:a new hypothesis of perfluorocarbon liquid induced retinopathy . Invest Ophthalmol Vis Sci ,2000;41(1):256-261
18 Sparrow JR, Ortiz R, Macleish PR, Chang S. Fibroblast behavior at aqueous interface with perfluorocarbon,silicone,and fluorosilicone liquids. Invest Ophthalmol Vis Sci ,1990;31(4):638-646
19 Green K, Slagle T, Chaknis MJ, Cheeks L, Chang S. Perfluorocarbon effect on rabbit blood retinal barrier permeability. Ophthalmic Res ,1993;25(3):186-191
20 Berkowitz BA, Wilson CA, Hotchell DL. Oxygen kinetics in the vitreous substitute perfluorotributylamine:A 19F NMR study in vivo. Invest Ophthalmol Vis Sci ,1991;32(8):2382-2387
21 Ito Y,Berkowitz BA.MR studies of retinal oxygenation.Vision Res ,2001;41(10-11):1307-1311
22 Sparrow JR, Jayakumar A, Berrocal M, Ozmert E, Chang S. Experimental studies of the combined use of vitreous substitutes of high and low specific gravity. Retina ,1992;12(2):134-140
23 Peyman GA, Conway MD, Soike KF Clark LC Jr. Long term vitreous replacement in primates with intravitreal vitreon or vitreon plus silicon oil. Ophthalmic Surg ,1991;22(11):657-664
24 Sleep TJ, Luff AJ, In vivo formation of heavy oil. Retina ,1999;19(3):251-255
25 Hoerauf H, Faude F, Menz DH, Dresp J, Wiedemann P, Laqua H. Determination of the solubility of perfluorocarbon liquids in silicon oil in vitro and vivo . Retina ,2002;22(2):163-168
26 Ciardella AP, Langton K, Chang S. Intraocular dispersion of perfluorocarbon liquids in silicone oil. Am J Ophthalmol ,2003;136(2):365-367
27 Friberg TR, Siska PE, Somayajula K, Williams J, Eller AW. Interactions of perfluorocarbon liquids and silicone oil as characterized by mass spectrometry. Graefes Arch Clin Exp Ophthamol ,2003;24(10):809-815
28 Moreira CA, Bryk A, Kmomatsu MC, Vanzo LC. Bacterial growth in perfluorocarbon liquids:An in vitro study. Retina ,2001;21(5):533-535
29 Moreira CA, Uscocovich CE, Moreira AT. Experimental studies with perfluorooctane for hemostasis during vitreoretinal surgery. Retina ,1997;17(6):530-534
30 Chang S, Ozmert E, Zimmerman NJ. Intraoperative perfluorocarbon liquids in the management of proliferative vitreoretinopathy. Am J Ophthalmol ,1988;106(6):668-674
31 Banker AS, Freeman WR, Vander JF, Flores Aguilar M, Munguia D. Use of perflubron as a new temporary vitreous substitute and manipulation agent for vitreoretinal surgery. Retina ,1996;16(4):285-291
32 Millsap CM, Peyman GA, Mehta NJ, Greve MD, Lee KJ, Ma PE, Dunlap WA. Perfluoroperhydrophenanthrene in the management of giant retinal tears :Results of a collaborative study. Ophthalmic Surg ,1993:24(11):759-762
33 Ambresin A, Wolfensberger TJ, Bovey EH. Management of giant retinal tears with vitrectomy, internal tamponade and peripheral 360 degrees retinal photocoagulation. Retina ,2003;23(5)622-628
34 Verma L. Gogoi M, Tewari HK, Kumar A, Talwar D. Comparative study of vitrectomy for dropped nucleus with and without the use of perfluorocarbon liquid. Acta Ophthalmol Scand ,2001;79(4):354-358
35 Roldan-pallares, Sanchez M. Vitreous luxated PC-IOLs:Complication. J Fr Ophthalmol ,2002;25(2):154-160
36 Soheilian M, Peyman GA, Wafapoor H, Navarro GC, Thompson H. Surgical management of traumatic retinal detachment with perfluorocarbon liquid.The vitreon group. Int Ophthalmol ,1996-97;20(5):241-249
37 Desai UR, Peyman GA. Perfluorocarbon liquid in traumatic vitreous hemorrhage and retinal detachment . Ophthalmic Surg ,1993;24(8):537-541
38 Desai UR, Peyman GA, Chen CJ, Nelson NC, Alturki WA, Blinder KJ, Paris CL. Use of perfluoroperhydrophenanthrene in the management of suprachoroidal hemorrhage. Ophthalmology ,1992;99(10):1542-1547
39 Meier P, Wiedemann P. Massive suprachoroidal hemorrhage: secondary treatment and outcome. Graefes Arch Clin Exp Ophthalmol ,2000;238(1):28-32
40 Nishimura A, Kita K, Segawa Y, Shirao Y. Perfluorocarbon liquid assists in stripping the ILM to treat detached retina caused by macular hole. Ophthalmic Surg lasers ,2002;33(1):77-78
41 Brazitikos PD, Androudi S, Dimitrakos SA, Stangos NT. Removal of the internal limiting membrane under perfluorocarbon liquid to treat macular hole associated retinal detachment. Am J Ophthalmol ,2003;135(6):894-896
42 Facino M, Mochi B, Lai S, Terrile R. A simple way to prevent indocyanine green from entering the subretinal space during vitrectomy for retinal detachment due to myopic macular hole. Eur J Ophthalmol ,2004;14(3):269-271
43 Millsap CM, Peyman GA. The surgical management of retinopathy of prematurity using a perfluorocarbon liquid. Int Ophthalmol ,1994;18(2):97-100
44 Forlini C, Del Fiume E. Use of PFCL in the surgical management of endophthalmitis:new indicators. J Vitreo Retina ,1992;1:55-63
45 Kamei M, Tano Y, Maeno T, Ikuno Y, Mitsuda H, Yuasa T. Surgical removal of submacular hemorrhage using tissue plasminogen activaton and perfluorocarbon liquid. Am J Ophthalmol ,1996;121(3):267-275
46 Imamura Y, Minami M, Ueki M, Satoh B, Ikeda T. Use of perfluorocarbon liquid during vitrectomy for severe proliferative diabetic retinopathy. Br J Ophthalmol ,2003;87(5):563-566
47 Lee KJ, Peyman GA, Paris CL, Alturki WA, Desai UR. Management of retinal detachment associated with choroidal coloboma using perfluoroperhydrophenanthrene. Ophthalmic Surg ,1992;23(8):563-564
48 Brazitikos PD, Androudi S, Damico DJ. Perfluorocarbon liquid utilization in primary vitrectomy repair of retinal detachment with multiple breaks. Retina ,2003;23(8):615-621
49 Lomeo MD, Diaz-Rohena R, Lambert HM. Use of perfluorocarbon liquid in the repair of retinoschisis retinal detachment. Ophthalmic Surg Lasers ,1996;27(9):778-781
50 Vartanyan AH, Hovhannisyan TA. Application of perfluorocarbon liquid in the removal of metallic intraretinal foreign bodies. Med Sci Monit ,2002;8(2):CR66-71
51 Chen HC, Ho JD, Chen SN. Perfluorocarbon liquid assisted external drainage in the management of central serous chorioretinopathy with bullous serous retina detachment. Chang Gung Med J ,2003;26(10):777-781
52 Paris CL, Peyman GA, Blinder KJ, Alturki W, Dailey JP, Barron BA.Surgical technique for managing rhegmatogenous retinal detachment following prosthokeratoplasth. Retina ,1991;11(3):301-304
53 Garcia-arumi J, Sararols L, Martinez V, Corcostegui B. Vitreoretinal surgery and endoresection in high posterior choroidal melanomas. Retina ,2001;21(5):445-452
54 Brown AD, Kirkby GR. Removal of subretinal gas using perfluorocarbon liquid. Retina ,1997;17(1):70-71
55 Cekic O, Ohji M, Tano Y, Chang S. Continuous outflow devices for macular translocation with 360 degree retinotomy. Am J Ophthalmol ,2003;135(2):241-243
56 Nemeth J, Suveges I. Echographic sign of perfluorodecalin. Am J Ophthalmol ,1993;115(5):679-680
57 Milisap CM. Perfluoroperhydrophenanthrene is radiopque. Ophthalmic Surg ,1993;24(7):500
58 Manfre L, Fabbri G, Avitabile T, Biondi P, Reibaldi A, Pero G. MRI and intraocular tamponade media. Neuroradiology ,1993:35(5):359-361
59 Anat L, Humayyun MS, Juan E, Campochiaro PA. Haller JA.Perfluoroperhydrophenanthrene versus perfluoronoctane in vitreoretinal surgery. Ophthalmology ,2000;107(6):1078-2000
60 Scott IU, Murray TG, Flynn Jr HW, Smiddy WE,Feuer WJ, Schiffman JC. Outcome and complication associated with perfluoronoctane and perfluoroperhydrophenanthrene in complex retinal detachment repair. Ophthalmology ,2000;107(5):860-865
61 Liang C, Peyman GA. Tolerance of extended term vitreous replacement with perfluoronoctane and perfluoroperhy drophenanthrene mixture. Retina ,1999;19(3):230-237
62 Ji YZ, Pei S, Wu YJ, Huo WL, Chen YJ. Phacoemulsification combined with trabeculectomy. Int J Ophthalmol (Guoji Yanke Zazhi) ,2006;6(4)888-889
63 Xiao Y, Wang J, Li JH, Liu J, Wang L, Sun HY, Gao ZJ. Posterior continuous capsulorhexis in longenital cataract extraction. Int J Ophthalmol (Guoji Yanke Zazhi) ,2005;5(6):1178-1179
64 Wang Z, Xia Q, Liu XW, Cui BH. Influence of posterior capsule opacification on visual function. Int J Ophthalmol (Guoji Yanke Zazhi) ,2006;6(2):377-380
65 Han DP, Rychwalski PJ, Mieler WF, Abrams GW. Management of complex retinal detachment with combined relaxing retinotomy and intravitreal perfluoronoctane injection. Am J Ophthalmol ,1994;118(1):24-32
66 Lesnoni G, Rossi T, Gelso A. Subfoveal liquid perfluorocarbon . Retina ,2004;24(1):172-176
67 Garcia-Valenzuela E, Ito Y, Abrams GW. Risk factors for retention of subretinal perfluorocarbon liquid in vitreoretinal surgery. Retina ,2004;24;(5):746-752
68 Roth DB, Sears JE, Lewis H. Removal of retained subfoveal perfluoronoctane liquid. Am J Ophthalmol ,2004;138(2):287-289
69 Huang JY, Yang CM. Intraocular formation of heavy oil in the subretinal space. Jpn J Ophthalmol ,2004;48(1):75-77
70 Tanji TM, Peyman GA, Mehta NJ, Millsap CM. Perfluoroperhydrophenanthrene as a short term vitreous substitute after complex vitreoretinal surgery. Ophthalmic Surg ,1993;24(10):681-685
71 Blinder KJ, Peyman GA, Desai UR, Nelson NC Jr, Alturki W, Paris Cl.Vitreon,a short term vitreoretinal tamponade. Br J Ophthalmol ,1992;76(9):525-528
72 Singh J, Ramaesh K. Wharton SB, Cormack G, Chawla HB. Perfluorodecalin induced intravitreal inflammation. Retina ,2001;21(3):247-251
73 Quiroz-mercado H, Suarez-tata L, Magdalenic R, Murillo-Lopez, Garcia-Aguirre G.Perfluorocarbon perfused vitrectomy:animal studies. Am J Ophthalmol ,2004:137(2):287-293
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