Abstract
The authors describe a case of spontaneous globe rupture during instillation of perfluoro-n-octane (PFO) during retinal surgery. A 71-year-old male with a macular-involving rhegmatogenous retinal detachment underwent pars plana vitrectomy. During instillation of PFO manually on a single-bore cannula by the assisting resident, spontaneous globe rupture occurred superotemporally in an area with no visible underlying structural abnormalities. Factors that led to this complication include the use of single-bore cannula, error in judgment of resistance during PFO injection, and inexperience. This is the first report of this complication without an identifiable structural abnormality predisposing patient to perforation.
Highlights
Perfluoro-n-octane (PFO) is a perfluorocarbon liquid (PFCL) used in retina surgery to aid in the aspiration of subretinal fluid (SRF) and stabilization of the retina during vitrectomy due to its characteristics including low viscosity, high density, transparency, and clarity [1, 2]
Diamint et al reported a case with spontaneous globe rupture during PFO instillation via vitrectomy probe, but that patient was found to have an area of severe scleromalacia at the rupture site [6]
Three other cases have been reported in the literature of the development of emphysema after PFO instillation, but none of these were thought to be directly due to a PFO-related injury
Summary
Perfluoro-n-octane (PFO) is a perfluorocarbon liquid (PFCL) used in retina surgery to aid in the aspiration of subretinal fluid (SRF) and stabilization of the retina during vitrectomy due to its characteristics including low viscosity, high density, transparency, and clarity [1, 2]. When the junior resident experienced resistance with the PFO injection, he was supposed to pause instillation and alert the attending surgeon, who would manually release pressure via the superonasal trocar by intermittently removing the light pipe and engaging the valve. Diamint et al reported a case with spontaneous globe rupture during PFO instillation via vitrectomy probe, but that patient was found to have an area of severe scleromalacia at the rupture site [6].
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