Clinicopathological correlation of epiretinal membranes and posterior lens opacification following perfluorohexyloctane tamponade

Background/aims - Epiretinal and retrolental proliferation may occur during prolonged use of the novel tamponade agent perfluorohexyloctane (F H ). This study aims to determine whether there is any histological evidence that F H has a role in the formation of these membranes. Methods - Eight epiretinal membranes and three opaque posterior lens capsules were excised from patients in whom F H had been used as a long term retinal tamponade agent. The membranes and capsules were examined employing light microscopic methods, including immunohistochemistry. Results - The epiretinal membranes showed histological features typical of proliferative vitreoretinopathy (PVR) epiretinal membranes, but they also exhibited a dense macrophagic infiltration. In addition, three of the membranes contained multinucleated cells. Macrophages represented up to 30% of the cells present and appeared to contain large intracytoplasmic vacuoles. Similar cells were seen on the back of the posterior lens capsule in one specimen and all three capsules had posterior migration of lens epithelium. Conclusion - The pathological findings are not simply those of PVR. The macrophage infiltration suggests that there may be a biological reaction to F H which could reflect its surmised propensity to emulsify. Further investigations concerning the cellular response to this promising tamponade agent are warranted.