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Yoo, Nam, Lee, Lee, and Lee: Complications caused by perfluorocarbon liquid used in pars plana vitrectomy
Original Article

Kosin Medical Journal 2015;30(2):123-130.

Published online: 20 January 2015

DOI: https://doi.org/10.7180/kmj.2015.30.2.123

Complications caused by perfluorocarbon liquid used in pars plana vitrectomy

Jae Ho Yoo1, Ki Yup Nam2, Seung Uk Lee2, Ji Eun Lee2, Sang Joon Lee2,

1Oksan Health Subcenter, Euiseong-Gun, Korea

2Department of Ophthalmology, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: Sang Joon Lee, Department of Ophthalmology, College of Medicine, Kosin University, 262, Gamcheon-ro Seo-gu, Busan 49267, Korea TEL: +82-51-990-6228 FAX: +82-51-990-3026 E-mail: hhiatus@gmail.com

Received 20 February 201424 May 2014       Accepted 9 July 2014

Copyright © 2015 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

To assess the inadvertent intraocular retention of perfluorocarbon liquid (PFCL) after vitreoretinal surgery and their complications.

Methods

We retrospectively reviewed the medical records of 108 patients who underwent vitreoretinal surgeries using intraoperative PFCL (perfluoro-n-octane (C8F18), 0.69 centistoke at 25℃, PERFLUORN®, Alcon, USA) and the removal of PFCL through fluid-air exchange. The analysis was focused on the occurrence of intraocular retained PFCL, diagnoses, surgicalprocedures, and complications.

Results

Retinal detachment (51 cases, 47%) was the most common surgery which used PFCL intraoperatively. Other causes were vitreous hemorrhage (24 cases, 22%), posteriorly dislocated lens (22 cases, 21%), and trauma (11 cases, 10%). Intraocular PFCL was found in a total of 9 (8.3%) eyes. PFCL bubbles remained in anterior chamber and vitreous cavity were observed in 4 cases and subretinal retained PFCL was observed in 5 cases. Three of 5 cases of subretinal PFCL exhibited in subfoveal space. Among the three subfoveal cases, macular hole developed after PFCL removal in 1 case, epiretinal membrane in the area where had been PFCL bubble. However, we observed no complications in 1 case of subfoveal PFCL that was removed by surgery. PFCL in anterior chamber and vitreous cavity were in 4 cases.

Conclusions

The presence of subfoveal PFCL might affect visual and anatomic outcomes. However, subfoveal PFCL may induce visual complications, and therefore requires special attention.

Keywords: complicaton, Perfluorocarbon liquid, retinal detachment, Vitrectomy

References

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Fig. 1.
A. Anterior segment Photo shows multiple PFCL bubble in inferior anterior chamber.(red arrow) B. Postoperative retinography of case 5 showing multiple PFCL spheres in the posterior pole, extramacular.(red arrow) After 2 years, notice the reflexes caused by PFCL. The patient's visual acuity was 0.25. C. Postoperative retinography shows PFCL bubble at superior side of macula.(red arrow) D.Vertical OCT section of the "C" case was shown and the intraretinal black hollow (arrow head) was PFCL subretinal bubble.
kmj-30-123f1.tif
Fig 2.
A. Retinography shows round reflex at macular due to subfoveal PFCL and atrophic change around posterior pole due to laser treatment. B. After 48 months with secondary IOL implant, retinography shows no obvious anatomy changes.(red arrow) The patients last visual acuity was 0.125. C.Vertical OCT section of the "B" case was shown and subfoveal PFCL bubble was observed.(blue arrow head) D. Postoperative retinography showing yellowish glistening macula due to submacular PFCL.(red arrow) E. After 6 months, retinography shows inferiorly displaced PFCL (red arrow) and premacular gliosis and epiretinal membrane.(blue arrow head)
kmj-30-123f2.tif
Table 1.
Demographics of total patient and retained PFCL cases.
  Total Retained PFCL
No. of surgeries 108 9(8.3%)
Gender    
Male 80 8(10%)
Female 28 1(3.6%)
Age (years)    
Mean (S.D.) 57.25±15.10 52.11±18.78
Range 22–84 20–78
Follow-up period (month)    
Mean (S.D.) 21.73±17.73 26.92±20.01
Range 0.25–70 0.25–48
Time Left in (month)    
Mean (S.D.)   18.58±4.24
Range   0.25–48
Table 2.
Cumulative Percent of Eyes with Retained Perfluorocarbon Liquid
  Total No. of cases (%) Retained PFCL, No.(%)
Rhegmatogenous retinal detachment 45(42%) 5(11.1%)
Idiopathic 39(36%) 4(10.3%)
Trauma 6(6%) 1(16.7%)
Vitreous and Subretinal hemorrhage 31(29%) 0(0.0%)
Due to diabetic Retinopathy 22(20%) 0(0.0%)
Due to Trauma 5(5%) 0(0.0%)
Due to Retinal vein occlusion 2(2%) 0(0.0%)
Due to Age-related macular degeneration 1(1%) 0(0.0%)
Lens drop in vitreal cavity 21(19%) 3(14.3%)
Tractional retinal detachment 7(6%) 1(14.3%)
Suprachoroidal hemorrahge 2(2%) 0(0.0%)
Choroidal detachment 2(2%) 0(0.0%)
Total 108(100%) 9(8.3%)
Table3.
Patient Characteristics with retained PFCL
Pati ent AgeGend er Diagnosis Operation Site of PFCL PreOP VA PostOP VA Time Left in (month) Follow up period (month) Complic ation Futher Surgery
1 78 M RRD PPV, Lensectomy, SB, Gas inject Anterior chamber 0.075 0.1 0.25 0.25 nil nil
2 73 M Posterioly dislocated lens PPV, Phacofragm atome Anterior chamber CF CF 1 18 nil nil
3 51 M Posterioly dislocated lens PPV, Phacofragm atome Anterior chamber LP HM 1 2 nil nil
4 63 M Posterioly dislocated lens PPV, Phaco c Scleral fixed IOL Vitreal cavity HM 0.8 12 12 Floater nil
5 20 M RRD PPV, SB, SiO inject Extrafovea CF 0.25 24 24 nil nil
6 30 F RRD PPV, SB, C3F8 Gas Extrafovea CF 0.1 36 48 nil nil
7 57 F TRD, PDR inject PPV, SiO inject Subfovea CF HM 3 48 Macular hole PFCL removal
8 45 M RRD PPV, SB, FAX, EL, lensectomy, SiO inject Subfovea CF 0.125 48 48 nil Seconda ry IOL implant
9 52 M RRD PPV, SB, Lensectomy, SiO inject Subfovea CF HM 42 42 ERM nil
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