This patient presented with a retinal detachment caused by a giant retinal tear extending from 5 to 11 o’clock.
Unfortunately, the retina re-detached since the eye was inadvertently underfilled with perfluorocarbon (PFO) at the time of vitrectomy. The superior edge of the giant tear is open, resulting in a superior detachment. There are numerous small PFO bubbles floating along the interface between the PFO meniscus below and the liquid vitreous above.
The patient underwent subsequent surgery to remove the Perfluoron and successfully repair the superior detachment.
Learning Points:
PFO is a transparent, heavier-than-water liquid, often used during vitrectomy for these types of detachments. The PFO liquid is injected over the posterior pole, and as it fills the eye, it simultaneously unrolls the giant tear and flattens the retina. Traditionally, the PFO is exchanged for air, then for a long-acting gas. However, this often results in posterior retinal slippage.
Although PFO is not meant as a long-term vitreous substitute, it can be left in the eye for a week or two. Postoperatively, the patient sleeps on their back, allowing the PFO to tamponade the retina while the retinopexy begins to scar. Patients are then taken back to the operating room, where the PFO can be removed and replaced with a gas or silicone oil, without concern about the retina slipping intraoperatively.
