Medium-Term Perfluoro-N-Octane as Rescue Postoperative Tamponade for Very Complex Retinal Detachments

Abstract

Purpose: To report the anatomical and functional outcomes of medium-term perfluoro-noctane (PFO) tamponade as a rescue procedure in very complex retinal detachments (RDs).Methods: We reviewed the case records of 35 consecutive patients who underwent vitrectomy for very complex RDs due to diverse etiologies. The surgical complexity was so graded because of the intraoperative failure to ascertain complete retinal reattachment; perfluoro-n-octane was used as rescue tamponade for 2 to 4 weeks. The second intervention included additional membrane peeling, retinectomy, endophotocoagulation, and gas/silicone oil tamponade. The minimum follow-up was 3 months after the final intervention: the primary outcome was retinal reattachment and the secondary outcome was change in best-corrected visual acuity (BCVA).Results: The most common presentations were severe trauma with retinal incarceration, preretinal and subretinal hemorrhage, or chronic/recurrent RDs with anterior proliferative vitreoretinopathy. Preoperative BCVA was #counting fingers in 31 (88.6%) patients. Complete retinal attachment without any tamponade was achieved in 33 (94.3%) eyes. bestcorrected visual acuity improved in 30 (85.7%) eyes: 16 (45.7%) had BCVA $20/200 and 21 (60%) regained ambulatory vision ($5/200). Two eyes developed keratopathy, and four needed antiglaucoma medications. Conclusion:We achieved excellent anatomical outcomes and acceptable functional outcomes in nearly inoperable RDs with few side effects. Medium-term perfluoro-n-octane tamponade can be used as a salvage procedure in very complex RDs where intraoperative reattachment cannot be ensured.RETINA 43:905-912, 2023C omplex or complicated retinal detachments (RDs) have been variously defined in the literature as those associated with proliferative vitreoretinopathy (PVR), trauma, inflammation, giant retinal tears, and postsurgical recurrences. [1][2][3][4] The unifying pathology in this heterogeneous compilation is PVR. The 5% to 10% cases of RDs that develop PVR remain a formidable challenge for vitreoretinal surgeons, notwithstanding the decades of innovations and improvements in surgical techniques, equipment, and adjuvants. 1 With progressive resurgeries and recurrent PVR, the chances of retinal reattachment and recovery of meaningful vision become bleaker. 3,5 At some point, the surgeon either declines further intervention 5 or takes the chance, sometimes only to abandon the procedure on the From the

Inflammatory retinal deposits after perfluoro-n-octane tamponade

“…We agree that residual silicone oil droplets after multiple surgeries could have emulsified PFO and accelerated the macrophage response. In our experience, access of PFO droplets to anterior chamber substantially reduced the inflammatory deposits on retina and posterior capsule and extended the inflammation-free period to 2 to 4 weeks 2 ; the protection probably does not last much further, as evidenced by the presently shared cases.…”

“…We also encountered inflammatory retinal deposits despite intentional posterior capsulotomy in a few of our patients, when they reported late for perfluoro-n-octane (PFO) removal. 2 Though the deposits could be removed in most cases, they did not cause persistent inflammation or proliferative vitreoretinopathy (PVR) when left behind, as also described by others. 3,4 The authors did not expand on any complications or sequels of the observed inflammatory response.…”

“…Unlike Viswanath et al, we removed PFO after 2 to 4 weeks in most cases. 2 It is well known that prolonged PFO tamponade causes more inflammation. 4 We have consistently observed this temporal relationship in our cases, irrespective of the number of previous surgeries or the nature of the preceding tamponade.…”

Effect of medium term PFCL tamponade on eyes previously filled with silicon oil

“…We thank Viswanath et al 1 for sharing their experience with the "Effect of PCFL tamponade on eyes previously filled with silicon oil," extending the discussion on potential hazards of this novel tamponade agent. We also encountered inflammatory retinal deposits despite intentional posterior capsulotomy in a few of our patients, when they reported late for perfluoro-n-octane (PFO) removal.…”

“…We read with interest the manuscript by Dr Dhananjay Shukla et al, 1 “Medium-term perfluoro-n-octane as rescue postoperative tamponade for very complex retinal detachments,” published in the February issue of the journal RETINA, doi: https://doi.org/10.1097/iae.0000000000003763. February 14, 2023.…”