PERFLUOROCARBON LIQUID IN THE MANAGEMENT OF RETINAL-DETACHMENT WITH PROLIFERATIVE VITREORETINOPATHY

Purpose: To describe the techniques and results of perfluoro-N-octane used during vitrectomy for managing retinal detachment with severe pro liferative vitreoretinopathy (PVR). Methods: The authors retrospective ly studied 223 consecutive patients who underwent vitreoretinal surger y for severe PVR (93% D1-D3). Patients underwent an average of 1.72 pr ior vitreoretinal surgeries. Perfluoro-N-octane was used intraoperativ ely to flatten the retina, avoiding posterior drainage retinotomy, to identify areas of residual retinal traction and periretinal membranes, to stabilize the peripheral retina during dissection of anterior PVR, and to help determine the extent and location of relaxing retinotomie s. Extended-term gas tamponade was used in 91% of eyes. Ail patients w ere followed for a minimum of 6 months. Results: Seventy-eight percent of the retinas were reattached posterior to the scleral buckle after a single vitreoretinal surgery and 96% were reattached after multiple surgeries. An average of 1.24 vitrectomy surgeries were required. The final visual acuity was 20/400 or better in 74% of eyes and 20/80 or b etter in 30% (P = 0.004). Preoperative hypotony (intraocular pressure less than or equal to 5 mmHg) and multiple prior vitreoretinal surgeri es were associated with a poor final visual acuity (P = 0.01 and 0.02, respectively). Preoperative hypotony (intraocular pressure less than or equal to 5 mmHg) was associated with a greater frequency of relaxin g retinotomies (P = 0.02). Retained perfluoro-N-octane was observed po stoperatively in the Vitreous cavity in 1.3% and subretinal perfluoro- N-octane in 0.9%. Conclusion: Experience with perfluoro-N-octane has d emonstrated its usefulness both diagnostically and therapeutically as an intraoperative tool and improved the anatomic and visual outcome fo r retinal detachment complicated by severe PVR.