Acute intraocular toxicity caused by perfluorocarbon liquids: safety control systems of medical devices

Background Acute retinal toxicity has been demonstrated to be associated with the intraoperative use of perfluorocarbon liquids (PFCLs), especially perfluorooctane (PFO). Recently, several cases of PFO-associated blindness have been reported in Spain, Holland, France, Italy, the Middle East, and South America. Methods As a result, a new ISO guideline (ISO 16672:2020) was drafted, discussed, approved, and released in 2019. This recent ISO16672:2020 guideline recommends performing direct cytotoxicity tests as an option along with chemical analysis to measure PFCL quality (purity and safety). Results In this review paper, it has been emphasized why an appropriate biological test, specifically direct exposure of PFCL to live cells, for measuring cytotoxicity must be performed with each PFCL batch along with chemical analysis. Conclusions The paper intends to compile all available information to discuss possible approaches for avoiding adverse clinical cases in future.

Automated summary

This review paper emphasizes the importance of conducting appropriate biological tests and chemical analysis when measuring cytotoxicity of PFCLs (perfluorocarbon liquids). The recent ISO guideline (ISO 16672:2020) recommends performing direct cytotoxicity tests as an option to measure PFCL quality.