Densiron improves visual outcomes in eyes with primary RRD

Densiron, a heavier-than-water endotamponade agent, may be used in the treatment of primary rhegmatogenous retinal detachment (RRD) in eyes with predominantly inferior retinal pathology and proliferative vitreoretinopathy (PVR) grade C, as shown by its higher anatomic success rates and improved visual outcomes relative to conventional light silicone oil (LSO), suggests a study.

“We have demonstrated that the resulting effect estimates are unbiased and likely generalizable to other populations like ours,” said lead author Dr Nikolaos Tzoumas from the Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.

Tzoumas and his team conducted a cohort study using routinely collected data from the European Society of Retina Specialists and British and Eire Association of Vitreoretinal Surgeons vitreoretinal database between 2015 and 2022. They included all consecutive eyes (n=1,061) that underwent primary RRD surgery using Densiron 68 or LSO as an internal tamponade agent.

The research team used regression models, including prognostically relevant covariates, treatment-covariate interactions, and matching weights, as well as g-computation with cluster-robust methods to estimate the marginal effects. They also calculated confidence intervals (CIs) using bias-corrected cluster bootstrapping with 9,999 replications in nonlinear models.

The primary outcomes measured were the presence of a fully attached retina and visual acuity (VA) at least 2 months after oil removal.

Of the eyes enrolled, 426 and 239 were included in the matched samples for anatomic and visual outcome analyses, respectively. Eyes in the Densiron 68 group had a higher primary success rate than those in the LSO group (113 of 142, 80 percent vs 180 of 284, 63 percent; adjusted odds ratio, 1.90, 95 percent CI, 1.63‒2.23; p<0.001). [Ophthalmology 2024;131:731-740]

Postoperative VA also improved significantly in the Densiron 68 group (logarithm of the minimum angle of resolution [logMAR], ‒0.26, 95 percent CI, ‒0.43 to ‒0.10; p=0.002). Eyes with PVR grade C received the greatest anatomic benefit from using Densiron tamponade.

In addition, “[w]e found no evidence of visual effect moderation by anatomic outcome or foveal attachment,” Tzoumas said.

Previous research

The finding of a high primary success rate in primary RRD repair with inferior retinal pathology among eyes treated with Densiron supports that of earlier observational studies. [BMJ Open Ophthalmol 2022;7e001018; Int J Retin Vitr 2022;8:61; Ophthalmic Res 2007;39:198-206; Int J Ophthalmol 2014;7:469-473; Sci Rep 2023;13:3729]

A retrospective study by Romano and colleagues reported 91 percent of eyes achieving primary retinal reattachment with one operation and 94 percent attaining final anatomic success. Another study by Kocak and Koc comparing Densiron with LSO found a higher retinal reattachment rate after oil removal among Densiron-treated eyes. Both studies reported improvements in mean VA after using Densiron. [Graefes Arch Clin Exp Ophthalmol 2008;246:1541-1546; Int J Ophthalmol 2013;6:81-84]

“Further research is warranted to confirm the causal pathways between Densiron use and improved outcomes and to investigate potential adverse events associated with its use,” Tzoumas said.