Abstract
-
Objectives
- To assess the inadvertent intraocular retention of perfluorocarbon liquid (PFCL) after vitreoretinal surgery and their complications.
-
Methods
- We retrospectively reviewed the medical records of 108 patients who underwent vitreoretinal surgeries using intraoperative PFCL (perfluoro-n-octane (C8F18), 0.69 centistoke at 25℃, PERFLUORN®, Alcon, USA) and the removal of PFCL through fluid-air exchange. The analysis was focused on the occurrence of intraocular retained PFCL, diagnoses, surgicalprocedures, and complications.
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Results
- Retinal detachment (51 cases, 47%) was the most common surgery which used PFCL intraoperatively. Other causes were vitreous hemorrhage (24 cases, 22%), posteriorly dislocated lens (22 cases, 21%), and trauma (11 cases, 10%). Intraocular PFCL was found in a total of 9 (8.3%) eyes. PFCL bubbles remained in anterior chamber and vitreous cavity were observed in 4 cases and subretinal retained PFCL was observed in 5 cases. Three of 5 cases of subretinal PFCL exhibited in subfoveal space. Among the three subfoveal cases, macular hole developed after PFCL removal in 1 case, epiretinal membrane in the area where had been PFCL bubble. However, we observed no complications in 1 case of subfoveal PFCL that was removed by surgery. PFCL in anterior chamber and vitreous cavity were in 4 cases.
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Conclusions
- The presence of subfoveal PFCL might affect visual and anatomic outcomes. However, subfoveal PFCL may induce visual complications, and therefore requires special attention.
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Keywords: complicaton; Perfluorocarbon liquid; retinal detachment; Vitrectomy
Fig. 1.A. Anterior segment Photo shows multiple PFCL bubble in inferior anterior chamber.(red arrow) B. Postoperative retinography of case 5 showing multiple PFCL spheres in the posterior pole, extramacular.(red arrow) After 2 years, notice the reflexes caused by PFCL. The patient's visual acuity was 0.25. C. Postoperative retinography shows PFCL bubble at superior side of macula.(red arrow) D.Vertical OCT section of the "C" case was shown and the intraretinal black hollow (arrow head) was PFCL subretinal bubble.
Fig 2.A. Retinography shows round reflex at macular due to subfoveal PFCL and atrophic change around posterior pole due to laser treatment. B. After 48 months with secondary IOL implant, retinography shows no obvious anatomy changes.(red arrow) The patients last visual acuity was 0.125. C.Vertical OCT section of the "B" case was shown and subfoveal PFCL bubble was observed.(blue arrow head) D. Postoperative retinography showing yellowish glistening macula due to submacular PFCL.(red arrow) E. After 6 months, retinography shows inferiorly displaced PFCL (red arrow) and premacular gliosis and epiretinal membrane.(blue arrow head)
Table 1.Demographics of total patient and retained PFCL cases.
|
Total |
Retained PFCL |
No. of surgeries |
108 |
9(8.3%) |
Gender |
|
|
Male |
80 |
8(10%) |
Female |
28 |
1(3.6%) |
Age (years) |
|
|
Mean (S.D.) |
57.25±15.10 |
52.11±18.78 |
Range |
22–84 |
20–78 |
Follow-up period (month) |
|
|
Mean (S.D.) |
21.73±17.73 |
26.92±20.01 |
Range |
0.25–70 |
0.25–48 |
Time Left in (month) |
|
|
Mean (S.D.) |
|
18.58±4.24 |
Range |
|
0.25–48 |
Table 2.Cumulative Percent of Eyes with Retained Perfluorocarbon Liquid
|
Total No. of cases (%) |
Retained PFCL, No.(%) |
Rhegmatogenous retinal detachment |
45(42%) |
5(11.1%) |
Idiopathic |
39(36%) |
4(10.3%) |
Trauma |
6(6%) |
1(16.7%) |
Vitreous and Subretinal hemorrhage |
31(29%) |
0(0.0%) |
Due to diabetic Retinopathy |
22(20%) |
0(0.0%) |
Due to Trauma |
5(5%) |
0(0.0%) |
Due to Retinal vein occlusion |
2(2%) |
0(0.0%) |
Due to Age-related macular degeneration |
1(1%) |
0(0.0%) |
Lens drop in vitreal cavity |
21(19%) |
3(14.3%) |
Tractional retinal detachment |
7(6%) |
1(14.3%) |
Suprachoroidal hemorrahge |
2(2%) |
0(0.0%) |
Choroidal detachment |
2(2%) |
0(0.0%) |
Total |
108(100%) |
9(8.3%) |
Table3.Patient Characteristics with retained PFCL
Pati ent AgeGend er |
Diagnosis |
Operation |
Site of PFCL |
PreOP VA |
PostOP VA |
Time Left in (month) |
Follow up period (month) |
Complic ation |
Futher Surgery |
1 78 M |
RRD |
PPV, Lensectomy, SB, Gas inject |
Anterior chamber |
0.075 |
0.1 |
0.25 |
0.25 |
nil |
nil |
2 73 M |
Posterioly dislocated lens |
PPV, Phacofragm atome |
Anterior chamber |
CF |
CF |
1 |
18 |
nil |
nil |
3 51 M |
Posterioly dislocated lens |
PPV, Phacofragm atome |
Anterior chamber |
LP |
HM |
1 |
2 |
nil |
nil |
4 63 M |
Posterioly dislocated lens |
PPV, Phaco c Scleral fixed IOL |
Vitreal cavity |
HM |
0.8 |
12 |
12 |
Floater |
nil |
5 20 M |
RRD |
PPV, SB, SiO inject |
Extrafovea |
CF |
0.25 |
24 |
24 |
nil |
nil |
6 30 F |
RRD |
PPV, SB, C3F8 Gas |
Extrafovea |
CF |
0.1 |
36 |
48 |
nil |
nil |
7 57 F |
TRD, PDR |
inject PPV, SiO inject |
Subfovea |
CF |
HM |
3 |
48 |
Macular hole |
PFCL removal |
8 45 M |
RRD |
PPV, SB, FAX, EL, lensectomy, SiO inject |
Subfovea |
CF |
0.125 |
48 |
48 |
nil |
Seconda ry IOL implant |
9 52 M |
RRD |
PPV, SB, Lensectomy, SiO inject |
Subfovea |
CF |
HM |
42 |
42 |
ERM |
nil |
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Citations
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