Release and extraction of retained subfoveal perfluorocarbon liquid facilitated by subretinal BSS, vibration, and gravity: a case report

Abstract Background 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. Case presentation 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. Conclusion 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.

Download Full-text

Internal limiting membrane graft as a treatment for the retinal detachment secondary to an optic disc coloboma

European Journal of Ophthalmology ◽

10.1177/1120672121992686 ◽

2021 ◽

pp. 112067212199268

Author(s):

Jorge Fernández-Engroba ◽

Muhsen Saman ◽

Jeroni Nadal

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Optic Disc ◽

Subretinal Fluid ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Subretinal Space ◽

Direct Closure ◽

Retinal Tears ◽

Optic Disc Coloboma

Purpose: To report our anatomical outcome with the internal limiting membrane (ILM) graft procedure in the management of rhegmatogenous retinal detachment (RRD) secondary to optic disc coloboma (ODC). Methods: Description of a new surgical procedure in one eye of one patient who underwent pars plana vitrectomy (PPV) combined with ILM graft technique. Subsequent follow-up included optical coherence tomography (OCT) and visual acuity. Results: After only 1 week, the OCT revealed the ILM graft plugging the retinal tear with complete resorption of subretinal fluid. The sealing effect of this graft persisted after 6 months. However, visual outcome was poor and corrected distance visual acuity was 20/200 as a result of the previous long-standing retinal detachment with loss of photoreceptors. Conclusion: We suggest that ILM graft could be performed as a first line treatment in the management of RRD secondary to ODC. This direct closure of the retinal tears, allows a quick and effective interruption of the communication between the subretinal space and the vitreous cavity. Detecting these retinal tears and applying this technique as soon as possible could achieve not only an earlier anatomical success but obtain good visual results in retinal tears with RRD secondary to ODC. Further studies will be necessary to provide more evidences

Download Full-text

Surgical treatment of «dry» forms of central chorioretinal dystrophy with the use of platelet-rich blood autoplasma

Kazan medical journal ◽

10.17750/kmj2017-390 ◽

2017 ◽

Vol 98 (3) ◽

pp. 390-393

Author(s):

D G Arsjutov

Keyword(s):

Surgical Treatment ◽

Pigment Epithelium ◽

Vitreoretinal Surgery ◽

Internal Limiting Membrane ◽

Hyaline Membrane ◽

The Impact ◽

Observation Period ◽

Subretinal Injection ◽

Sodium Solution

Aim. To study the impact of platelet-rich blood autoplasma on the capability of the retinal regeneration in nonexudative forms of central chorioretinal dystrophy with the use of microinvasive vitreoretinal surgery. Methods. Surgical treatment was performed on 14 patients with central chorioretinal dystrophy aged 29 to 87 years. The surgery technique consisted of 3-port 25+, 27 Ga vitrectomy with posterior hyaline membrane and internal limiting membrane peel with subsequent central retinal exfoliation with 38 Ga cannula and balanced sodium solution and subretinal injection to the formed in macule space 0.1-0.2 ml of platelet-rich autolplasma. Results. As a result of the treatment according to this technique during the long-term period after the surgery (1 to 9 months) thickness of fovea reduced to 85-150 µm in average staying stable during the whole observation period. In 9 patients pigment epithelium thickened from 24 to 38 µm in parafoveolar area and fovea area. Corrected vision in 3 patients reached 0.1, and in the rest it did not exceed 0.06, herewith, all patients noted consistently improved vision. All patients had favorable evolution of photosensitivity according to microperimetry in average from 0.1-0.5 to 8.5-11 dB with a tendency of fixation point movement from periphery to the center. Conclusion. Vitreoretinal surgery 25+, 27 Ga for nonexudative forms of central chorioretinal dystrophy with the use of subretinal injection of platelet-rich autoplasma is a microinvasive, safe, effective method of the treatment of such pathology improving vision characteristics and anatomical and physiological characteristics of the eye involved.

Download Full-text

Direct Transretinal Removal of Subfoveal Perfluorocarbon Liquid: The Role and Timing of Internal Limiting Membrane Peeling

European Journal of Ophthalmology ◽

10.5301/ejo.5000934 ◽

2017 ◽

Vol 27 (2) ◽

pp. 249-252 ◽

Cited By ~ 4

Author(s):

Stefano De Cillà ◽

Micol Alkabes ◽

Paolo Radice ◽

Elisa Carini ◽

Carlos Mateo

Keyword(s):

Retinal Detachment ◽

Silicone Oil ◽

Case Series ◽

Vitreoretinal Surgery ◽

Internal Limiting Membrane ◽

Perfluorocarbon Liquid ◽

Ilm Peeling ◽

The Status ◽

Anatomic Results ◽

Silicone Oil Tamponade

Purpose To describe a case series including 4 patients undergoing direct transretinal aspiration of subfoveal perfluorocarbon liquid (PFCL) and internal limiting membrane (ILM) peeling after macula-off retinal detachment surgery. Methods Four patients who had undergone vitreoretinal surgery due to primary rhegmatogenous retinal detachment were further treated because of retained subfoveal PFCL. Direct transretinal aspiration of PFCL through a self-sealing foveal retinotomy was performed in all cases using a 41-G needle placed on the top of the bubble. The ILM was peeled off prior to and after PFCL removal in 2 cases, respectively. Optical coherence tomography (OCT) scans were obtained preoperatively and postoperatively to assess the status of the macula. Results Subfoveal PFCL was successfully removed in all cases. Two patients had silicone oil tamponade at the time of the second surgery, which was temporarily removed in both cases and then reapplied in one. Best-corrected visual acuity improved in all cases. No postoperative macular hole was observed by OCT. Conclusions Direct transretinal aspiration of subfoveal PFCL with a 41-G cannula combined with conventional ILM peeling is a safe and effective technique to avoid long-term damage to the retinal layers with good functional outcomes. Performing the ILM peeling immediately before or after the PFCL aspiration does not seem to influence anatomic results.

Download Full-text

Swept-source OCT findings in shaken baby syndrome: case report

BMC Ophthalmology ◽

10.1186/s12886-020-01666-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Imen Ksiaa ◽

Mohamed Ghachem ◽

Habib Besbes ◽

Sana Khochtali ◽

Slaheddine Chouchane ◽

...

Keyword(s):

Prognostic Value ◽

Shaken Baby Syndrome ◽

Internal Limiting Membrane ◽

Retinal Hemorrhages ◽

Vitreoretinal Interface ◽

Swept Source ◽

Case Presentation ◽

Retinal Atrophy ◽

Swept Source Oct

Abstract Background Our purpose was to document the swept source optical coherence tomography (SSOCT) findings in a patient with Shaken baby syndrome (SBS). Case presentation SSOCT was obtained without sedation in a six-month-old girl with bilateral multilayered retinal hemorrhages due to SBS. It documented vitreoretinal interface abnormalities, including internal limiting membrane (ILM) detachment with retinal traction, in association with other specific changes in the inner and outer retinal layers. Six weeks later, retinal hemorrhages had substantially resolved, and there was optic disc pallor. OCT showed ILM reattachment with release of retinal traction and the development of severe diffuse retinal atrophy involving the fovea. Conclusions SS OCT can provide useful information in SBS, revealing a wide variety of vitreoretinal interface, inner, and outer retinal changes not detected by clinical examination. It also may have a prognostic value over follow-up.

Download Full-text

Folding the internal limiting membrane flap under perfluorocarbon liquid in large, chronic and myopic macular holes

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-019-04439-3 ◽

2019 ◽

Vol 257 (11) ◽

pp. 2367-2373

Author(s):

Tommaso Rossi ◽

Carlandrea Trillo ◽

Herman D. Schubert ◽

Serena Telani ◽

Paola Cirafici ◽

...

Keyword(s):

Internal Limiting Membrane ◽

Perfluorocarbon Liquid ◽

Macular Holes

Download Full-text

Direct transretinal removal of subfoveal perfluorocarbon liquid combined with internal limiting membrane peeling

Therapeutic Advances in Ophthalmology ◽

10.1177/2515841419840244 ◽

2019 ◽

Vol 11 ◽

pp. 251584141984024

Author(s):

Burak Erden ◽

Serkan Erdenöz ◽

Akın Çakır ◽

Selim Bölükbaşı ◽

Mustafa Elçioğlu

Keyword(s):

Internal Limiting Membrane ◽

Perfluorocarbon Liquid ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling

Download Full-text

Two Cases of Rhegmatogenous Retinal Detachment Associated with Asteroid Hyalosis

Case Reports in Ophthalmology ◽

10.1159/000485888 ◽

2018 ◽

Vol 9 (1) ◽

pp. 49-54

Author(s):

Yoshitaka Okuda ◽

Keigo Kakurai ◽

Takaki Sato ◽

Seita Morishita ◽

Masanori Fukumoto ◽

...

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Posterior Vitreous Detachment ◽

Vitreous Surgery ◽

Retinal Surface ◽

Case Presentation ◽

Corrected Visual Acuity ◽

Vitreous Cortex ◽

Asteroid Hyalosis ◽

Flap Tear

Background: To report two cases of rhegmatogenous retinal detachment (RRD) associated with asteroid hyalosis (AH). Case Presentation: Two patients presented with RRD originating from a flap tear. Case 1 involved a 62-year-old male who was found to have bullous RRD in his left eye originating from a flap tear. During vitreous surgery, a thick vitreous cortex was found to have strongly adhered to the entire retinal surface, from the center to the periphery. A bimanual method was then used in conjunction with the vitrectomy to create an artificial posterior vitreous detachment. After surgery, the retina was successfully reattached, and his corrected visual acuity (VA) improved. Case 2 involved a 70-year-old male who was found to have localized RRD in his left eye originating from a flap tear. During vitreous surgery, a thick vitreous cortex was found to have strongly adhered to the entire retinal surface. After surgery, the retina was successfully reattached, and his corrected VA improved. Conclusions: RRD associated with AH presents with stronger vitreoretinal adhesion compared to typical RRD, thus requiring a more complicated surgical technique to properly treat the patient.

Download Full-text

Bilateral Giant Retinal Tear and Sequential Vitrectomy

Case Reports in Ophthalmology ◽

10.1159/000479728 ◽

2017 ◽

Vol 8 (2) ◽

pp. 436-439

Author(s):

Mushawiahti Mustapha ◽

Edward Roufail Franzco

Keyword(s):

Case Report ◽

Retinal Detachment ◽

Silicone Oil ◽

Perfluorocarbon Liquid ◽

Excellent Outcome ◽

Retinal Tear ◽

Giant Retinal Tear ◽

Retinal Tears ◽

The Right ◽

Outcome Of Surgery

Purpose: To describe the excellent outcome of surgery for bilateral giant retinal tears (GRTs) with better options of endotamponade. Methods: This is a case report of a 62-year-old man who presented with bilateral GRTs and associated retinal detachment. The tear in the right eye was supero-temporal and silicone oil was used as an endotamponade. The tear in the left eye was infero-temporal and perfluorocarbon liquid was used as an endotamponade. Results: The outcome at 6 months after surgery was excellent with visual acuities of 6/6 in both eyes. Conclusion: Improved availability of endotamponade agents allows repair of bilateral GRTs to be done at the same time, with good surgical outcomes.

Download Full-text