Subretinal Fluorescein Injection for Intraoperative Identification of Occult Retinal Breaks in Retinal Detachment Surgery

Summary

Surgical technique: Intra-operative sub-retinal fluorescein injection helps identify occult retinal breaks.

Abstract

Purpose: This study evaluates the feasibility and utility of subretinal fluorescein dye injection in identifying retinal breaks during retinal detachment vitrectomy.

Methods: Fluorescein dye was diluted to a concentration ranging from 0.01 mg/mL to 0.001 mg/mL and delivered via 41-G needle to the subretinal space. Four retinal detachment surgeries were performed using the NGENUITY and CONSTELLATION systems. A blue filter was adapted to the CONSTELLATION light source, and image gain was increased on the NGENUITY system to enhance visualization. Fluorescein dye leaked through the retinal break, thereby enabling its identification.

Results: Fluorescein leakage effectively facilitated the precise localization of the retinal break in the four cases described. No signs of retinal toxicity or adverse effects were observed. All patients experienced stable anatomical reattachment throughout the follow-up. Electroretinogram in two patients showed no signs of retinal toxicity.

Conclusion: Subretinal fluorescein dye injection offers a valuable adjunct for identifying elusive primary retinal breaks, especially in recurrent or persistent retinal detachments in vitrectomized eyes, complementing standard vitreous base vitrectomy inspection. Precise localization may reduce reliance on additional retinotomies, perfluorocarbon liquids, or extensive laser treatments, minimizing surgical risks. Further studies are necessary to evaluate the long-term efficacy, safety profile, and potential complications associated with this technique.