Perfluorocarbon-perfused vitrectomy: a new method for vitrectomy—a safety and feasibility study

Abstract

To evaluate the safety and feasibility of perfluorocarbon-perfused vitrectomy (PCPV) as a technique during vitrectomy for proliferative diabetic retinopathy (PDR) and rhegmatogenous retinal detachment (RRD). In an experimental, prospective, noncomparative and interventional study, 28 eyes of 28 patients were submitted to vitrectomy with the PCPV technique, 18 eyes with PDR and 10 with RRD. In this technique we replaced the traditional balanced saline solution (BSS) in the infusion line (conventional vitrectomy) by perfluorocarbon liquids (PCL). Some patients with PDR were treated with oxygenated PCL. Clinical evaluation, electroretinography (ERG), and endothelial cell count (ECC) were used to assess the safety of this procedure. An arbitrary grading system (grades 0-5) was used to classify the surgery and maneuvers to assess feasibility. No eyes had a significant decrease in ECC, and the patients in whom we could obtain ERG postoperatively showed no significant differences from preoperative ERG. In the PDR group (using oxygenated and nonoxygenated PCL), 77.8% were graded 5/5; in the RRD group 90% were 5/5. PCPV allowed better visualization of vitreous and intraocular structures, rapid retinal reattachment, less blood in the vitreous cavity, subretinal fluid resolution, blood confinement, retinal stabilization, and easier dissection of epiretinal membranes. In all cases at least one surgical step was eliminated. PCPV in humans is a safe and feasible technique. Probably in selected cases the use of PCL offers several advantages over BSS, because of their properties (gravitational forces, immiscibility with bodily fluids, and ability to transport oxygen). Prospective and comparative studies are necessary to establish formal indications and possible contraindications.