Intraoperative Perfluorocarbon Liquid Tamponade Technique for Treatment of Extensive Retinal Detachment Secondary to a Myopic Macular Hole

Abstract

Background/purpose: To report an intraoperative perfluorocarbon liquid (PFCL) tamponade technique in treating extensive retinal detachment secondary to a myopic macular hole (MH) through pars plana vitrectomy.

Methods: The technique was applied in nine eyes with MH-RD extending two quadrants or more areas. The procedures for pars plana vitrectomy included: 1). thorough drainage of subretinal fluid through the MH with fluid-air exchange; 2). PFCL tamponade on the macular area for more than 10 minutes; and 3). repairing the MH after PFCL was removed.

Results: All nine eyes gained intraoperative retinal reattachment after PFCL tamponade for 22.22 ± 8.01 minutes and removal of PFCL. Procedures for MH closure included internal limiting membrane peeling in eight eyes, with internal limiting membrane free flap insertion (four eyes), internal limiting membrane inverted flap insertion (two eyes), or lens capsular flap transplantation (three eyes). All eyes received C3F8 tamponade. During 9.11 ± 3.89 months of follow-up, eight of the nine eyes (89%) achieved retinal reattachment and MH closure; one eye achieved anatomical success after reoperations. All eyes had vision improvement at the last follow-up.

Conclusion: This new technique in pars plana vitrectomy may promote anatomical and functional recovery in the treatment of extensive retinal detachment secondary to a myopic MH.

Conflict of interest statement

None of the authors has any conflicting interests to disclose.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.

Figures

Fig. 1.

Schematic drawing to show the main steps of the surgical technique used in the present study. 1). Drainage of SRF with a 23-gauge silicone-tipped flute needle through a MH in a balanced salt solution-filled eye (A and B), followed by fluid–air exchange (C) to flatten the retina. 2). Approximately 1 to 2 mL PFCL was injected into the vitreous cavity to cover the posterior retina (D). The PFCL bubble remained in the lower part of the vitreous cavity for more than 10 minutes while balanced salt solution was introduced into the upper part of the vitreous cavity by air–fluid exchange using a vitrector or a flute needle (E). 3). Removal of the PFCL bubble with a silicone tipped flute needle (F) and subsequent macular surgery (G).

Fig. 2.

Preoperative (A and B) and postoperative (C and D) fundus images by ultra-wide-field scanning laser ophthalmoscope (UWF SLO, Optos PLC; dunfermline, Scotland, United Kingdom) and optical coherence tomography (OCT, by HRA + OCT SPECTRALIS, Heidelberg, Germany) scans taken from patient 9. He had a 682-µm MH (B, arrow) and total RD with a large amount of SRF (*) in his left eye (A) and the BCVA was hand motion. He underwent a PPV with intraoperative PFCL tamponade technique. Internal limiting membrane (ILM) peeling and inverted ILM flap insertion were performed. The MH was closed with inserted ILM tissue (arrow) and retina was reattached 3 months post-PPV. C and D. His BCVA was 20/150 5 months post-PPV.

Fig. 3.

Preoperative (A and B) and postoperative (C and D) fundus images by ultra-wide-field scanning laser ophthalmoscope and optical coherence tomography (OCT, RTVue XR, Optovue, CA) scans taken from patient 4. She had RD secondary to an MH (B, arrow pointing to the MH, and “*” for SRF) and received a PPV with silicone oil tamponade 3 months before current admission. The eye had retinal star folds (A, red circles) in the temporal quadrant and subretinal emulsified silicone oil (A, blue circle), and her BCVA was hand motion. PPV with silicone oil removal and membrane peeling was performed. PFCL tamponade technique and lens capsular sheet transplantation was conducted. Retinotomy was performed in the peripheral to aspirate subretinal silicone oil, and laser coagulation on the border of these breaks was conducted before the fluid–air exchange. After 3 months, MH closure with inserted capsular sheet tissue (D, arrow) and retinal reattachment (C and D) were achieved and BCVA was counting finger. Laser burns in the peripheral retina were observed (C, blue circle).