Takahashi Kosuke, Kimura Shuhei, Hosokawa Mio Morizane, Shiode Yusuke, Doi Shinichiro, Matoba Ryo, Kanzaki Yuki, Yonekawa Yoshihiro, Morizane Yuki
Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan.
Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA.
BMC Ophthalmol. 2020 Oct 23;20(1):427. doi: 10.1186/s12886-020-01698-1.
Perfluorocarbon liquid (PFCL) is an effective surgical adjuvant in performing vitrectomy for severe vitreoretinal pathologies such as proliferative vitreoretinopathy and giant retinal tears. However, subretinal retention of PFCL can occur postoperatively and retained PFCL causes severe visual disorders, particularly when PFCL was retained under the fovea. Although several procedures have been proposed for subfoveal PFCL removal, such as direct aspiration or submacular injection of balanced salt solution (BSS) to dislodge the subfoveal PFCL, the retinal damage associated with these procedures has been a major problem. Here, we report a case of subfoveal retention of PFCL for which we performed a novel surgical technique that attempts to minimize retinal damage.
A 69-year-old man presented with subfoveal retained PFCL after surgery for retinal detachment. To remove the retained PFCL, the internal limiting membrane overlying the subretinal injection site is first peeled to allow low-pressure (8 psi) transretinal BSS infusion, using a 41-gauge cannula, to slowly detach the macula. A small drainage retinotomy is created with the diathermy tip at the inferior position of the macular bleb, sized to be slightly wider than that of the PFCL droplet. The head of the bed is then raised, and the surgeon gently vibrates the patient's head to release the PFCL droplet to allow it to migrate inferiorly towards the drainage retinotomy. The bed is returned to the horizontal position, and the PFCL, now on the retinal surface, can be aspirated. The subfoveal PFCL is removed while minimizing iatrogenic foveal and macular damage. One month after PFCL removal, the foveal structure showed partial recovery on optical coherence tomography, and BCVA improved to 20/40.
Creating a macular bleb with low infusion pressure and using vibrational forces and gravity to migrate the PFCL towards a retinotomy can be considered as a relatively atraumatic technique to remove subfoveal retained PFCL.
全氟碳液体（PFCL）是一种有效的手术辅助剂，用于对增殖性玻璃体视网膜病变和巨大视网膜裂孔等严重玻璃体视网膜疾病进行玻璃体切除术。然而，术后可能会出现PFCL的视网膜下残留，残留的PFCL会导致严重的视觉障碍，尤其是当PFCL保留在黄斑下时。尽管已经提出了几种用于去除黄斑下PFCL的方法，如直接抽吸或黄斑下注射平衡盐溶液（BSS）以排出黄斑下的PFCL，但这些方法相关的视网膜损伤一直是一个主要问题。在此，我们报告一例黄斑下PFCL残留病例，我们采用了一种新的手术技术，试图将视网膜损伤降至最低。
一名69岁男性在视网膜脱离手术后出现黄斑下PFCL残留。为了去除残留的PFCL，首先剥除覆盖视网膜下注射部位的内界膜，使用41号套管针进行低压（8 psi）经视网膜BSS灌注，以缓慢分离黄斑。用透热疗法尖端在黄斑泡的下方位置制作一个小的引流视网膜切开术，其大小略宽于PFCL液滴。然后将床头抬高，外科医生轻轻晃动患者头部，以使PFCL液滴释放，使其向下朝向引流视网膜切开术迁移。床恢复到水平位置，此时位于视网膜表面的PFCL即可被抽吸。在将黄斑下PFCL去除的同时，将医源性黄斑和视网膜损伤降至最低。PFCL去除后1个月，光学相干断层扫描显示黄斑结构部分恢复，最佳矫正视力提高到20/40。
以低灌注压力形成黄斑泡，并利用振动力和重力使PFCL向视网膜切开术迁移，可以被认为是一种相对无创的技术，用于去除黄斑下残留的PFCL。
