Perfluorocarbon liquids (PFCL) are a versatile adjunct during vitreoretinal surgery particularly during the management of retinal detachment complicated by proliferative vitreoretinopathy (PVR), giant retinal tears (GRT) or retinal detachment resulting from open globe injury.[1,2,3,4] PFCL are also helpful as a “third hand” in selected types of primary retinal detachment, dislocated lens fragments, and dislocated intraocular lenses as well as IOFBs, and other vitreoretinal manoeuvres. Specifically, perfluoro-n-octane (PFO) is used in the United States but in other countries, perfluorodecalin (PFD) and perfluorophenanthrene are also used. The properties of PFO which make it desirable for intraoperative use are its clarity, a specific gravity of 1.7, a similar viscosity to saline, and a high vapor pressure. It is highly purified for medical application.
To minimize complications from using PFO, it is advised that during vitrectomy, the following instruments also be used:
Chang S, Kwun RC. Perfluorocarbon Liquids in Vitreoretinal Surgery in RETINA (ed. Ryan SJ, Wilkinson CP) Chapter 128, pp 217-2190, 4th Edition, 2006. Elsevier-Mosby (St. Louis)
Coll GE, Chang S, Sun J, Wieland MR, Berrocal MH. Perfluorocarbon liquids in the management of retinal detachment with proliferative viteoretinopathy. Ophthalmology 1995; 102:630-639.
Gonzalez MA, Flynn Jr HW, Smiddy WM, Albini TA, Tenzel P. Surgery for retinal detachment in patients with giant retinal tear: etiologies, management strategies, and outcomes. Ophthal. Surg Laser Imaging Retina 2013; 44:232-237.
Chang S, Reppucci V, Zimmerman NJ, Heinemann MH, Coleman DJ. Perfluorocarbon liquids in the management of Traumatic retinal detachments. Ophthalmology 1989; 96:785-791.
As PFO fills the eye:
Place the soft-tip cannula near the most posteriorly located retinal break, and begin aspirating peripheral anterior vitreous fluid (active or passive aspiration). As the air comes into the eye, the anterior retina flattens and subretinal fluid will be displaced back into the vitreous. When the anterior retina is flat, begin to aspirate the PFO starting at the top surface of the bubble. You might have to return to internal aspiration of subretinal fluid if some becomes visible. If the break is at the ora serrata, PFO can be filled all the way to the ora serrata and the fluid-air exchange can be performed there. If the break is posterior, PFO can be filled to the most posterior break and the fluid air exchange can be performed there. Any subretinal fluid anterior to the PFO bubble will be pushed out of the break as air enters anterior and the extrusion canula continues to aspirate at the break (Figure 5.2.5).
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