Korean J Ophthalmol.  2013 Oct;27(5):392-395. 10.3341/kjo.2013.27.5.392.

Surgical Removal of Retained Subfoveal Perfluorocarbon Liquid through a Therapeutic Macular Hole with Intravitreal PFCL Injection and Gas Tamponade

• Kim JM
• Woo SJ
• Park KH
• Chung H

• KMID: 1707297
• DOI: http://doi.org/10.3341/kjo.2013.27.5.392

Abstract

We report two cases of surgical removal of a retained subfoveal perfluorocarbon liquid (PFCL) bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade. Two patients underwent pars plana vitrectomy with PFCL injection for rhegmatogenous retinal detachment. In both cases, a retained subfoveal PFCL bubble was noticed postoperatively by funduscopy and optical coherence tomography. Both patients underwent surgical removal of the subfoveal PFCL through a therapeutic macular hole and gas tamponade. The therapeutic macular holes were completely closed by gas tamponade and the procedure yielded a good visual outcome (best-corrected visual acuity of 20 / 40 in both cases). In one case, additional intravitreal PFCL injection onto the macula reduced the size of the therapeutic macular hole and preserved the retinal structures in the macula. Surgical removal of a retained subfoveal PFCL bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade provides an effective treatment option.

Keyword

Gas tamponade; Macular hole; Subfoveal perfluorocarbon liquid

MeSH Terms

Aged
Female
Fluorocarbons/*administration & dosage
Follow-Up Studies
Fovea Centralis
Humans
Intravitreal Injections
Retinal Perforations/diagnosis/physiopathology/*surgery
Suction/*methods
Tomography, Optical Coherence
Visual Acuity
Vitrectomy/*methods
Fluorocarbons

Figure

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  Fig. 1 Preoperative fundus photography (left) and macular optical coherence tomography (right). (A) Case 1. (B) Case 2. Retained subfoveal perfluorocarbon liquid is shown in both cases.

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  Fig. 2 Intraoperative photographs of case 1. (A) Therapeutic retinal detachment was induced by injecting fluid through a retinotomy. (B) The perfluorocarbon liquid (PFCL) bubble (arrow head) popped up through a spontaneous macular hole (arrow). The dashed line indicates the margin of the therapeutic retinal detachment. We removed the subfoveal PFCL bubble and filled the eyeball with gas.

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  Fig. 3 Schematic drawings of the surgical technique performed in case 2. (A) Additional perfluorocarbon liquid (PFCL) was injected intravitreally to cover the posterior portion of the eyeball and to prevent abrupt PFCL expulsion through a macular hole (arrow). Retinotomy at the extremely thin retinal tissue just overlying the subfoveal PFCL bubble was created using the bent tip of a 23-gauge blade (arrowhead). (B) Subfoveal PFCL (bent arrow) was removed along with the intravitreal PFCL using a silicone-tipped backflush needle (arrowhead).

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  Fig. 4 Fundus photograph (left) and macular optical coherence tomography (right) 2 weeks after surgery. (A) Case 1. (B) Case 2. Note that the subfoveal perfluorocarbon liquid (PFCL) bubbles and macular holes disappeared in both cases and that the retinal structures were better persevered in case 2. (C) Follow-up spectral-domain optical coherence tomography of case 2 at 1 year after PFCL removal shows the well-preserved retinal structures in the macula.

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