Abstract
To study outcomes after using perfluoro-n-octane (PFO) as a short-term postoperative vitreous substitute in eyes undergoing primary vitrectomy with or without sclera buckling for complex rhegmatogenous retinal detachments with inferior/multiple breaks or giant retinal tears (GRTs) or retinal detachment with extensive proliferative vitreoretinopathy (PVR). A prospective study was carried out where in 43 patients (Group 1) PFO was exchanged with silicon oil in the same surgical procedure and in 22 patients (Group 2) PFO was kept for 3 days and then exchanged with silicon oil by a separate surgical procedure. The respective surgeon took the decision whether to exchange PFO on the same day or after 3 days. The patients were followed up for 6 months to analyze the anatomical attachment rates, visual acuity gain, and postoperative complications in both the groups. There were 33 male and 10 female patients in group 1 and 18 male and 4 female patients in group 2. Mean age distribution in group 1 was 38.88 years (SD ± 21.45) and in group 2 was 38.09 years (SD ± 16.36). Mean preoperative best corrected visual acuity in group 1 was 2.02 ± 0.58 and in group 2 was 2.01 ± 0.53 logarithm of the minimum angle of resolution (LogMAR). The LogMAR Visual acuity in group 1 improved to 1.76 ± 0.43 after 1 month (P = 0.01, paired t test) and to 1.62 ± 0.62 after 6 months (P = 0.01, paired T test). This visual acuity in group 2 improved to 1.85 ± 0.42 after 1 month (P = 0.24, paired T test) and 1.90 ± 0.72 after 6 months (P = 0.49, paired T test). There was no difference regarding visual improvement in between two groups after 1 month and 6 months of follow-up (P = 0.125, independent sample T test). The retina was detached in 6 patients (14%) in group 1 and in 7 patients (31%) in group 2 after 6 months of follow-up. There was no statistically significant difference in between two groups regarding final attachment of retina (P = 0.109, Fisher exact test). There was also no significant complication. like increased posterior capsular opacification or glaucoma found after retaining PFO for 3 days. Conclusion: Perfluoro-n-octane is efficacious and safe as a short-term vitreous substitute in primary rhegmatogenous retinal detachment repair cases with inferior/multiple breaks or GRTs or with extensive PVR. But keeping perfluoro-n-octane for 3 days does not significantly reduce the risk of re-detachment with complex rhegmatogenous retinal detachment cases.
Highlights
Perfluorocarbon liquid (PFCL) is colourless and odourless, and has a high density and low viscosity
Retinal re-detachment after retinal reattachment surgery in eyes with a giant retinal tears (GRTs), extensive proliferative vitreoretinopathy (PVR), multiple breaks in more than one retinal quadrant, and/or inferior breaks may be attributed in some instances to inadequate or unidirectional retinal tamponade with SO or gas, especially when a stringent continuous posturing regimen is not adhered to
If fluid is permitted to seep back under the edge of the tear before laser/cryoretinopexy has developed into a firm chorioretinal adhesion, the tear may reopen in the postoperative period
Summary
Perfluorocarbon liquid (PFCL) is colourless and odourless, and has a high density and low viscosity. Perfluorocarbon liquids possess a number of characteristics that make them quite useful in vitreoretinal surgery They have a high specific gravity (1.6-2.1) relative to saline, which results in their excellent retinal tamponade effect. They have a high interfacial tension that makes them cohesive enough to remain as a single large bubble. They are optically clear fluids with refractive indices only slightly different than saline. This slight difference in refractive index allows for easy visibility of the different fluid interfaces Their boiling point is greater than saline such that endophotocoagulation can be performed without resulting in intraocular vaporization. They have low viscosity allowing for easy injection and removal with microsurgical instruments.[9]
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