IMMEDIATE SUBRETINAL FLUID DISPLACEMENT FROM THE BUOYANT FORCE OF A SMALL GAS BUBBLE IN PNEUMATIC RETINOPEXY: INSIGHTS INTO THE POTENTIAL MECHANISM OF RETINAL DISPLACEMENT AFTER RETINAL DETACHMENT REPAIR.

Purpose: To demonstrate how a small gas bubble injected into the vitreous cavity in pneumatic retinopexy for rhegmatogenous retinal detachment causes immediate displacement of subretinal fluid and to gain insights into the potential mechanism of retinal displacement.
Methods: Three patients with rhegmatogenous retinal detachment who underwent pneumatic retinopexy were enrolled and prospectively followed. All patients underwent ultra-widefield fundus photography at baseline and at 1 to 2 minutes after intravitreal gas injection.
Results: In all cases, the ultra-widefield fundus photograph demonstrated immediate displacement of subretinal fluid, suggesting that the buoyant force applied to the retina by the bubble was responsible for the displacement of subretinal fluid. The results were extrapolated to determine the buoyant force applied by a small and large gas bubble as in pneumatic retinopexy and pars plana vitrectomy. We determined that the buoyant force applied with a larger bubble in pars plana vitrectomy was substantially greater, and this may lead to retinal displacement.
Conclusion: Intravitreal gas applies significant buoyant force to the detached retina and subretinal fluid that leads to substantial and rapid displacement of subretinal fluid. Understanding the affect of the buoyant force of the gas bubble on the detached retina can provide insight into possible mechanisms of retinal displacement.
Competing Interests: R. H. Muni is a consultant, has participated in advisory boards, and receives research funding from Novartis, Bayer, and Allergan, none of which are relevant to this work. W. W. Lee, A. Ramchandran, H. Hamli, L. C Escaf, and A. Bansal declare no conflicts of interest.