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

Displacement of Submacular Hemorrhage With Vitrectomy Combined With Subretinal Balanced Salt Solution and Air

PURPOSE

To describe a technique of displacement of submacular hemorrhage (SMH) using subretinal injection of balanced salt solution and filtered air.

METHODS

Patients presenting within 2 weeks of massive SMH (>4 disk diameter) were prospectively included. All patients underwent 25-gauge pars plana vitrectomy, posterior vitreous detachment, injection of subretinal balanced salt solution and filtered air followed by partial fluid air exchange, 20% sulfur hexafluoride tamponade, and heads-up positioning postoperatively. Degree of displacement of SMH was assessed at 1 month and change in best-corrected visual acuity was assessed at 3 months.

RESULTS

Ten patients with massive SMH who underwent the aforementioned procedure were included. Complete displacement of bleed from the macula was achieved in nine (90%) of 10 eyes at 1 month. There was significant improvement in best-corrected visual acuity from baseline at 1 month ( P = 0.015) and 3 months ( P = 0.043).

CONCLUSION

Pars plana vitrectomy with injection of subretinal balanced salt solution and filtered air was well-tolerated and efficacious in displacing large and thick SMH in patients operated within 2 weeks of onset of symptoms.

Subretinal silicone oil: OCT imaging findings and surgical management of a rare and unusual iatrogenic complication of retinal detachment surgery

A man in his 50s underwent vitrectomy surgery for a macular off retinal detachment which was complicated by intraoperative hypotony and suprachoroidal haemorrhage, resulting in the use of silicone oil tamponade. Postoperatively, several retained cysts of fluid were seen underneath the retina, one of which was large and close to the macular. Imaging was used to determine that this was likely retained silicone oil. Given the potential of migration to the macular and retinal toxicity, the decision was made to remove the larger oil bubbles under the retina. We explain how the oil may have got under the retina in this unusual case, how we dealt with it and discuss other cases of different substances under the retina and their appearance on ocular imaging.

Subfoveal perfluorocarbon liquid droplet can be removed without puncturing the retina

Subfoveal perfluorocarbon liquid (PFL) is a vision-threatening complication that requires removal as safely as possible. We experienced a surgical case of proliferative vitreoretinopathy, in which a subfoveal PFL droplet was removed through the fovea, without puncturing the retina. In this case, although the retina was completely attached after primary vitrectomy and cataract removal, a subfoveal PFL droplet was found. At the second surgery, after peeling the internal limiting membrane, the droplet was passively aspirated by placing a 25-gauge blunt needle on the surface of the retina. This useful technique avoids puncturing the retina and does not require the patient to maintain a specific position postoperatively.