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Prof. Zbiba on F4H5

Advantages of F4H5 in clinical use


Prof. Walid Zbiba
Head of department of ophthalmology at Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
Associate Professor in ophthalmology at faculty of Medicine of Tunis, Tunisia

Date: March 9th, 2020

GEUDER: How did you become aware of F4H5 washout and when did you first use it?

Prof. Zbiba: I was first introduced to the product while attending a retina congress in Europe. I started using F4H5 in my practice in 2017.

GEUDER: F4H5 washout can be used in different applications, such as silicone oil sticking to the retina or IOL, droplets in the zonulas of the trabecular meshwork or even sticky oil. Which are the key pathologies of the eye you apply F4H5 and why?

Prof. Zbiba: I am using it for all patients undergoing silicone oil removal and especially those with persistent silicone oil droplets, in the anterior chamber or sticking to the IOL or the retina. Using F4H5 improved my final surgical outcome mainly in patients with silicone oil induced glaucoma.

GEUDER: What feature do you like most about the product? (e.g. ability to dissolve sticky, application in angles of intraocular structure, intraocular behavior)

Prof. Zbiba: I like its ability to dissolve sticky silicone on the surface of the retina and its ease of use.

GEUDER: For which types of silicone oils (e.g. 1.000 / 5.000 cst) do you usually use F4H5 for? Only for a specific type or for different silicone oils? If you use it for different types of silicone oil, does it work well with all silicone oils or did you observe any differences?

Prof. Zbiba: I often use 1.300 and the 2.000 cst oils and I don’t really find a significant difference between the application of these two products, F4H5 works well in both cases.


GEUDER: Other surgeons have reported that F4H5 can help reduce the operation time, for example less repetitions of BSS-air exchange. What is your experience?

Prof. Zbiba: Effectively, I totally agree with this observation. The use of F4H5 can help reduce the operation time since there is no need to do multiple liquid-air exchanges to remove all silicone oil droplets. Regarding the number of BSS-air exchanges, I usually do three to four. I do not exceed four times since the risk of choroidal detachment becomes very high, unless valved trocars are used. But even by doing numerous exchanges, silicone oil particles or droplets may still be present post-operatively and patients were often unsatisfied, but with F4H5 patients' post operative satisfaction was better.

GEUDER: What is your estimation on how much F4H5 can help to reduce surgery time?

Prof. Zbiba: I noticed that surgery time was considerably decreased. I usually schedule two cases of silicone oil removal surgeries per operating day, actually I may perform four or five silicone oil removals per day since the operating time has been significantly reduced by employing F4H5. 


GEUDER: Do you apply F4H5 in the anterior chamber? If yes, how do you apply the product and why? (Please specify the procedure step by step if possible)

Prof. Zbiba:

  1. I place a 25G infusion trocar temporally and inferiorly
  2. I make a corneal paracentesis
  3. I fill the anterior chamber with F4H5
  4. I wait for five minutes
  5. I thoroughly wash the anterior chamber with BSS
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GEUDER: Do you think the application of F4H5 in the anterior chamber can help to prevent silicone oil induced secondary glaucoma? 

Prof. Zbiba: I think that F4H5 may be useful in preventing silicone oil glaucoma especially if silicone removal is done early before structural damage to the trabecular meshwork occur.

GEUDER: Can F4H5 be used in the anterior chamber to treat silicone oil induced glaucoma in your opinion? 

Prof. Zbiba: In my opinion, F4H5 may reduce the risk of silicone oil induced glaucoma, but cannot be defined as a treatment since the effect of silicone oil on the trabecular meshwork is complex and may not be reversible after silicone oil removal.

GEUDER: There are several structures in the anterior chamber which can make it difficult to remove silicone oil droplets (such as trabecular meshwork or irido-corneal angle). Do you have a special technique or method to make sure that F4H5 can also remove silicone oil droplets from such structures?

Prof. Zbiba: My method consists of gently brushing the trabecular meshwork with a silicone tip cannula five minutes after filling the anterior chamber with F4H5.


GEUDER: How do you apply F4H5 in the posterior segment / vitreous chamber? What are the different steps of your method? 

Prof. Zbiba:

  1. I start with three sclerotomies with valved trocars and inserting an infusion
  2. Silicone oil is actively aspirated with a special cannula
  3. Air-liquid exchange with an air pressure of 70 mm Hg
  4. I inject F4H5 through a 25G cannula, and then wait for five minutes
  5. Liquid-air exchange while keeping the F4H5 in the cavity
  6. Aspiration of F4H5 with a backflush retinal cannula
  7. Extraction of the trocars and closing of sclerotomies

"Video F4H5 Wash Out, by Prof. Zbiba"

GEUDER: In your description and video we see that you inject F4H5 under air. There are other surgeons who inject F4H5 under BSS. What is your opinion about this approach?

Prof. Zbiba: I tried F4H5 injection under BSS but I found it did not have the same efficacy as injecting F4H5 under air. The BSS-air exchange makes the silicone droplets accumulate under the air bubble at the posterior pole. When all droplets are aggregated there, I inject F4H5 under the air bubble so it is directly in contact with these silicone droplets and I wait for five minutes until the silicone dissolves with F4H5.


GEUDER: If you had to summarize your opinion on F4H5 washout in brief, what would you say?

Prof. Zbiba: F4H5 is simply safe, efficient and easy to use and should be used as standard in every silicone oil removal procedure.

GEUDER: Thank you very much for the interview!

(GEUDER: Ralf Schuler)