Perfluorocarbon liquid-assisted membrane staining and peeling technique for macular diseases

Iatrogenic macular hole following PFCL injection: Implications of retinal dimpling as an intraoperative indicator

Background

Perfluorocarbon liquid (PFCL) revolutionized retinal detachment (RD) management in vitreoretinal surgery but introduced unique risks. Complications like subretinal migration are documented, yet specific warnings for macular hole (MH) formation during PFCL injection are lacking.

Case presentation

In a rhegmatogenous RD case, a localized retinal dimpling during PFCL jet stream injection, preceded subsequent complications-an immediate MH and subretinal PFCL migration. Subsequently, an internal limiting membrane peeling with PFCL mobilization was performed.successfully managed the situation. Post-surgery, optical coherence tomography (OCT) confirmed a closed MH with improved vision.

Conclusion

This case report not only sheds light on a previously undocumented complication associated with PFCL injection but also underscores the critical need for adherence to proper injection technique to minimize traumatic effects. Understanding the mechanism underlying this complication and implementing corrective measures are essential for enhancing intraoperative strategies and minimizing adverse outcomes in retinal surgeries involving PFCL.

Dynamics of Epiretinal Membrane Peeling under Perfluorocarbon Liquid Evaluated by Intraoperative OCT

BACKGROUND

The aim of this study is to provide intraoperative data demonstrating a significant difference in the membrane peeling dynamics performed under a perfluorocarbon (PFCL) bubble, compared to normal balanced saline solution (BSS).

METHODS

This is a prospective, interventional, single-center study on a series of 36 consecutive eyes of 36 patients affected by primary epiretinal membrane (ERM). Eighteen eyes underwent standard ERM peeling, while 18 eyes received a PFCL-assisted procedure. Intraoperative optical coherence tomography (iOCT) B-Scans were collected to evaluate the displacement angle (DA) between the underlying retinal plane and the flap of epiretinal tissue, along with the number of times the surgeon had to grab the flap during the intervention. Follow-up visits were carried out at postoperative week 1 and months 1, 3 and 6.

RESULTS

The mean DA was 164.8° ± 4.0 in the PFCL-assisted group and 119.7° ± 8.7 in the standard group, with a statistically significant difference between groups (p < 0.001). Moreover, we found a significant difference in the amount of ERM grabs between the two groups (7.2 ± 2.5 in the PFCL-assisted group vs. 10.3 ± 3.1 in the standard group, p = 0.005). The mean BCVA and metamorphopsia significantly improved in both groups (p < 0.05), with no significant intergroup difference at all follow-up visits. Similarly, CST significantly decreased in both groups, and final CST was similar between the two groups (p = 0.719). Overall, three eyes in the standard group developed postoperative dissociated optic nerve fiber layer (DONFL, 16.6%), compared to none of the PFCL-assisted group.

CONCLUSION

We reported a statistically significant difference in the intraoperative peeling dynamics of the PFCL-assisted group, accounting for a decreased tendency in the tearing of the ERM flap and possibly reduced damage to the fiber layer, with equal effectiveness in improving visual function and foveal thickness.

Modified perfluorocarbon liquid/internal limiting membrane interface staining in myopic macular hole retinal detachment

PURPOSE

To demonstrate a modified technique of perfluorocarbon liquid (PFCL)/internal limiting membrane (ILM) interface staining in patients affected by macular hole retinal detachment (MHRD) in the setting of high myopia.

METHODS

Two-surgeon retrospective case series and review of surgical videos with step-by-step technique analysis.

RESULTS

Our modified technique was proficiently employed to treat 9 highly myopic patients affected by MHRD. Successful staining and peeling of the ILM with the creation of an inverted flap was achieved in all cases. A limited number of dye injections required to stain the ILM was noted. No subretinal dye migration or other intra- and postoperative complications were recorded.

CONCLUSION

Modified PFCL/ILM interface staining is a surgically efficient technique potentially reducing the risk of iatrogenic damage, including the toxicity of vital dyes to the retinal pigment epithelium (RPE) in myopic MHRD.

A Novel Subfoveal Perfluorocarbon Liquid Removal Technique Combining a 25-Gauge Retrobulbar Needle With a Built-in 30-Gauge Needle

Introduction

To report a novel combining a 25-gauge retrobulbar needle with a built-in 30-gauge needle surgical technique for subfoveal perfluorocarbon liquid (PFCL) removal.

Materials and Methods

Fourteen eyes of 14 patients who underwent subfoveal PFCL removal with a 25-gauge retrobulbar needle combined with a built-in 30-gauge needle were studied. The 30-gauge needle was inserted into the 25-gauge retrobulbar needle. The bent tip of the built-in 30-gauge needle was used to create a 30-gauge retinotomy at the farthest edge of the subfoveal PFCL droplet. Then, a flute cannula was used to aspirate the PFCL through the previously created retinotomy. The best-corrected visual acuity (BCVA) was determined, previous surgical history and post-operative complications were recorded.

Results

Fourteen cases were analyzed. Most eyes (92.85%) showed an improvement in BCVA after surgery. The mean change in the BCVA was −0.7 ± 0.72 logarithm of the minimum angle of resolution (logMAR) units (p = 0.006). Post-operative complications included a self-healing macular hole in one eye and vitreous hemorrhage in one eye. Post-operative optical coherence tomography confirmed removal of the subfoveal PFCL with restoration of the macular fovea.

Conclusion

Combining a 25-gauge retrobulbar needle with a built-in 30-gauge needle to remove subfoveal PFCL is easy to perform and carries little potential risk of subretinal impairment. This method also provides relatively good macular contour with functional improvement.

Development of traumatic bilateral horseshoe-shaped macular tear without vitreous traction: Case report

To report our findings in a case with bilateral horseshoe-shaped macular tears. Both eyes of a 68-year-old woman developed horseshoe-shaped macular tears in the absence of vitreous traction due to prior vitrectomy in one eye and a posterior vitreous detachment in the other eye. Vitrectomy with the inverted internal limiting membrane flap technique led to a successful closure of the macular tear bilaterally, and an improvement of her visual acuity in both eyes. The cause of horseshoe-shaped macular tear was most likely due to a retinal rupture from a blunt trauma.

Pharmacological Adjuncts to Vitrectomy Surgery

Pharmacological adjuncts to vitrectomy surgery are useful tools to better deal with surgery. Their introduction has enriched the therapeutic choice before, during and after operations. Although several classifications could be made to frame adjuncts to vitrectomy, we preferred to divide the pharmacological adjuncts to vitrectomy surgery for therapeutic use in the pre-operatory procedure (neo-adjuvant), for intraoperative use and for post-operatory practice (adjuvant). This type of classification allowed us to explore all the adjuncts based on the timing of their use. The actual interest in vitrectomy surgery is giving rise to considerable interest in new molecules with and without the pharmacological effect that will soon be available for the aid of vitreoretinal surgery.