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Supplemental Digital Content is Available in the Text. The authors describe a strategy for treating large and/or multiple subretinal perfluorocarbon liquid bubbles complicating previous surgery for rhegmatogenous retinal detachment. The innovation consists of the injection of air, associated with balanced salt solution, in the subretinal space. This procedure tested effective and safe in allowing macular detachment and bubbles' displacement for drainage. Purpose: The authors describe an original technique for treating multiple subretinal perfluorocarbon liquid (PFCL) bubbles complicating previous surgery for rhegmatogenous retinal detachment. Methods: To facilitate the induction of macular redetachment and peripheral displacement of the PFCL bubbles, we performed the subretinal injection of filtered air in addition to balanced salt solution. In this setting, the action of the PFCL in the vitreous cavity, combined with globe manipulation, allowed bubbles' displacement and full aspiration. Results: A 57-year-old man had a history of repeated pars plana vitrectomies for recalcitrant rhegmatogenous retinal detachment, the latter leading to multiple subretinal PFCL bubbles retained at the posterior pole. The described technique was performed 8 weeks after the last pars plana vitrectomy. A complete flattening of the macular region was obtained with visual improvement. Conclusion: Direct injection of air into the subretinal space may represent an effective strategy to help the surgical management of multiple retained PFCL bubbles. [ABSTRACT FROM AUTHOR]

Marc Saab,1 Simon Javidi,2 Ali Dirani,3 Ghassan Cordahi2 1Department of Ophthalmology, Hôpital Charles LeMoyne, Université de Sherbrooke, Longueuil, Québec, Canada; 2Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada; 3Department of Ophthalmology, CHU de Québec - Université Laval, Québec, Québec, CanadaCorrespondence: Simon JavidiDepartment of Ophthalmology, Université de Montréal, Montréal, Québec, CanadaEmail simon.javidi@gmail.comPurpose: To report a case of displacement of retained subretinal perfluorocarbon liquid (PFCL) through therapeutic retinal detachment (RD) induced by balanced salt solution (BSS) injection.Methods: This is a surgical case report. We present a case of a 61-year-old woman who presented with subretinal PFCL at the papillo-macular bundle with best-corrected visual acuity (BCVA) of 20/200 at four weeks following RD surgery in her right eye. She underwent a three-port pars plana vitrectomy with therapeutic RD of a portion of the posterior pole and inferior periphery induced by BSS injection, followed by complete air-fluid exchange, and kept an upright position for three days to force the displacement of the PFCL bubble towards the inferior retinal periphery. BCVA assessment, dilated fundus examination (DFE), and optical coherence tomography (OCT) were performed before and after the surgery.Results: Two weeks after the procedure, BCVA improved to 20/40, the subretinal PFCL was not visible on DFE, and a control OCT confirmed displacement of the PFCL bubble with atrophy at the papillo-macular bundle. There were no complications.Conclusion: Displacement of retained subretinal PFCL through therapeutic RD induced by BSS injection seems to be an effective technique with fewer potential complications in comparison to the more traditional approach of removal by direct aspiration.Keywords: perfluorocarbon liquid, subretinal perfluorocarbon liquid, vitreoretinal surgery, complication, retinal detachment

Submacular perfluorocarbon liquid (PFCL) retention is a well-known complication of vitreoretinal surgeries; however, the optimal surgical technique for the removal of subfoveal PFCL is yet to be determined. We describe a novel surgical technique for the removal of retained submacular PFCL by performing a retinotomy adjacent to the inferotemporal arcade using a 41-gauge extendible subretinal injection needle and inducing a therapeutic retinal detachment. Through the same retinotomy, the bent 41-gauge needle was advanced into the subretinal space to reach the PFCL bubble. Subsequently, active aspiration of PFCL was performed. The surgical procedure was successfully performed in two patients. This technique appears to be an effective surgical approach for removing retained submacular PFCL bubble.

Submacular perfluorocarbon liquid (PFCL) retention is a well-known complication of vitreoretinal surgeries; however, the optimal surgical technique for the removal of subfoveal PFCL is yet to be determined. We describe a novel surgical technique for the removal of retained submacular PFCL by performing a retinotomy adjacent to the inferotemporal arcade using a 41-gauge extendible subretinal injection needle and inducing a therapeutic retinal detachment. Through the same retinotomy, the bent 41-gauge needle was advanced into the subretinal space to reach the PFCL bubble. Subsequently, active aspiration of PFCL was performed. The surgical procedure was successfully performed in two patients. This technique appears to be an effective surgical approach for removing retained submacular PFCL bubble. [ABSTRACT FROM AUTHOR]

Optical coherence tomography of submacular perfluorocarbon liquid and its safe removal with a small gauge cannula have been presented in the report. This case was complicated by development of an epiretinal membrane, though visual acuity was preserved.

This study presents two cases that had subfoveal perfluorocarbon liquid (PFCL) after rhegmatogenous retinal detachment surgery. The first case was a 65-year-old pseudophakic male patient. The superior temporal retinal tear and a bullous retinal detachment that reached the macula border was observed in the right eye. The patient underwent 23 G pars plana vitrectomy (PPV). Intravitreal perfluorocarbon liquid was used to reattach the retina and perform laser retinopexy around the tear. The surgical procedure was ended by PFCL-air and air-silicone exchange. In the first month, subfoveal PFCL droplets were observed in the control examination. The patient, who was reoperated, was injected with an infusion liquid using a 38 G cannula from the perifoveal area; liquid and decalin droplets were re-aspired using a flute cannula. There were no PFCL droplets in the control examination. Visual acuity, which was 0.2 pre-operatively, increased to 0.3 post-operatively, but the patient complained of metamorphopsia . The second case was a 66-year-old male patient. There was a retinal tear in the right eye at the 5 o'clock position, and a retinal detachment in the lower half. The patient underwent a 23 G PPV operation. Intravitreal perfluorocarbon liquid was used to reattach the retina. First silicone and then heavy silicone oil was used in two subsequent surgeries. In the final control examination performed after silicone removal, PFCL was detected in the subfoveal area. The patient was followed up without surgery, had a visual acuity of 0.2, and a central scotoma was present in the superior temporal fixation center of the visual field. [ABSTRACT FROM AUTHOR]

Optical coherence tomography of submacular perfluorocarbon liquid and its safe removal with a small gauge cannula have been presented in the report. This case was complicated by development of an epiretinal membrane, though visual acuity was preserved. [ABSTRACT FROM AUTHOR]

Submacular perfluorocarbon liquid (PFCL) retention is a well-known complication of vitreoretinal surgeries; however, the optimal surgical technique for the removal of subfoveal PFCL is yet to be determined. We describe a novel surgical technique for the removal of retained submacular PFCL by performing a retinotomy adjacent to the inferotemporal arcade using a 41-gauge extendible subretinal injection needle and inducing a therapeutic retinal detachment. Through the same retinotomy, the bent 41-gauge needle was advanced into the subretinal space to reach the PFCL bubble. Subsequently, active aspiration of PFCL was performed. The surgical procedure was successfully performed in two patients. This technique appears to be an effective surgical approach for removing retained submacular PFCL bubble., Competing Interests: There are no conflicts of interest., (Copyright © 2019 Ghasemi Falavarjani and Anvari.)

Perfluorocarbon liquid was seen in subretinal space extrafoveally in inferonazal retina in a 40-year old patient undergone pars plana vitrectomy for rhegmatogeneous retinal detachment and detected by OCT. Because retina was attached at seventh month postoperatively, intraocular silicon oil was removed. In the first day of operation gathering of PFCL into two bubbles was detected. After one week gathering all PFCL bubbles and formation of one big PFCL bubble was detected by OCT. In this study tendency of PFCL to gather was delayed with the effect of silicon oil as tamponade was shown, however after removal of silicon oil gathering of PFCL completed in a short time. [ABSTRACT FROM AUTHOR]

Perfluorocarbon liquid was seen in subretinal space extrafoveally in inferonazal retina in a 40-year old patient undergone pars plana vitrectomy for rhegmatogeneous retinal detachment and detected by OCT. Because retina was attached at seventh month postoperatively, intraocular silicon oil was removed. In the first day of operation gathering of PFCL into two bubbles was detected. After one week gathering all PFCL bubbles and formation of one big PFCL bubble was detected by OCT. In this study tendency of PFCL to gather was delayed with the effect of silicon oil as tamponade was shown, however after removal of silicon oil gathering of PFCL completed in a short time. [ABSTRACT FROM AUTHOR]