How to remove subretinal fluid?

Abstract

AbstractPurpose Rhegmatogenous retinal detachments (RRD) can be repaired surgically using non‐drainage techniques. However,removal of subretinal fluid (SRF) remains an important surgical step in retinal detachments treated by scleral buckling, particularly in cases of bullous detachments, inferior breaks, proliferative vitreoretinopathy, high myopia, chronic detachments, cases with poor retinal pigment epithelium function and eyes intolerant to sustained intraocular pressure rise.Methods Conventional drainage techniques include passive needle drainage of subretinal fluid through a 3 to 4 mm radial sclerotomy within the bed of the buckle and closure with a preplaced suture. Many modified SRF drainage techniques have been described. Internal subretinal fluid drainage with simultaneous automated air‐fluid infusion is an important part of modern vitreoretinal surgery.Results Needle drainage, where the needle shaft is observed using an indirect ophthalmoscope, seemed to be associated with a higher success rate than conventional drainage. The most common complications of subretinal fluid drainage include subretinal hemorrhage, retinal incarceration, and retinal perforation. Using perfluorocarbon liquid or infusion of low‐molecular weight silicone oil as a peroperative tool, retinal flattening posterior to equator is an important step of the vitreoretinal approach and internal drainage for the treatment of RRD. Subretinal fluid is drained through a preexisting retinal break or an intentionally created drainage retinotomy using an extrusion cannula. It allows the immediate and complete reattachment of the retina and enables laser endocoagulation of the breaks. If the original retinal break can be treated by laser photocoagulation or cryopexy, the subretinal fluid is not necessarily removed completely.