Long-term Outcomes of Submacular Perfluorocarbon Liquid Removal with Internal Limiting Membrane Peeling and Transretinal Aspiration

Abstract

Background An important complication associated with perfluorocarbon liquid (PFCL) use during pars plana vitrectomy (PPV) is its retention in the submacular area. The aim of this study was to present the long-term outcomes of the surgical method used in this study to remove submacular PFCL and to shed light on the advantages and disadvantages compared to other methods.

Material and Methods This is a retrospective, single-center, observational study. Patients who underwent surgical intervention due to submacular PFCL were included in this study. The surgical procedural includes internal limiting membrane (ILM) peeling, transretinal aspiration of submacular PCFL with a 25/27-gauge soft-tipped cannula, then perfluoropropane (C₃F₈) gas tamponade, and facedown positioning for 5 days. The long-term anatomical and functional outcomes were evaluated with an ophthalmological examination and optical coherence tomography (OCT).

Outcomes A total of 15 patients with submacular PFCL were included in this study, and the mean age of the patients was 64.33 ± 10.36 years (47 – 83). The localization of submacular PFCL was subfoveal in nine patients (60.00%), non-subfoveal in four patients (26.67%), and both subfoveal and non-subfoveal in two patients (13.33%). The mean time of submacular PFCL diagnosis was 4.86 ± 1.02 weeks (2 – 8) and the mean time of the surgery was 9.80 ± 1.17 weeks (8 – 14). Complete removal of submacular PFCL was achieved in all cases (100%) and no significant treatment-associated complications were observed. The mean follow-up time was 37.60 ± 14.00 months (18 – 60) and the best-corrected visual acuity was significantly improved (p = 0.001). At the end of the follow-up time, prominent ellipsoid zone disruption was observed in six patients (40.00%), while in nine patients (60.00%), there was no prominent ellipsoid zone disruption.

Conclusions The surgical procedural for submacular PFCL removal is a reasonable option and improves visual acuity in the long term without any significant treatment-associated complications.

Zusammenfassung

Hintergrund Eine wichtige Komplikation im Zusammenhang mit der Verwendung von Perfluorkohlenstoffflüssigkeit (PKF) während der Pars-plana-Vitrektomie (PPV) ist ihre Retention im submakulären Bereich. Das Ziel dieser Studie ist es, die Langzeitergebnisse der in dieser Studie verwendeten Operationsmethode zur submakulären PKF-Entfernung darzustellen und die Vor- und Nachteile im Vergleich zu anderen Methoden zu beleuchten.

Material und Methoden Dies ist eine retrospektive monozentrische Beobachtungsstudie. Patienten, die sich einem chirurgischen Eingriff aufgrund einer submakulären PKF unterzogen, wurden in diese Studie eingeschlossen. Das chirurgische Verfahren umfasst: Peeling der inneren Begrenzungsmembran (IBM), transretinale Aspiration von submakulärer PKF mit einer 25/27-Gauge-Kanüle mit weicher Spitze, dann Perfluorpropan-Gastamponade (C₃F₈) und 5-tägige Lagerung mit dem Gesicht nach unten. Die langfristigen anatomischen und funktionellen Ergebnisse wurden mit ophthalmologischer Untersuchung und optischer Kohärenztomografie (OCT) bewertet.

Ergebnisse Insgesamt wurden 15 Patienten mit submakulärer PKF in diese Studie aufgenommen, und das Durchschnittsalter der Patienten betrug 64,33 ± 10,36 Jahre (47 – 83). Die Lokalisation der submakulären PKF war bei 9 Patienten (60,00%) subfoveal, bei 4 Patienten (26,67%) nicht subfoveal und bei 2 Patienten (13,33%) sowohl subfoveal als auch nicht subfoveal. Die mittlere Dauer der submakulären PKF-Diagnose betrug 4,86 ± 1,02 Wochen (2 – 8) und die mittlere Dauer der Operation 9,80 ± 1,17 Wochen (8 – 14). Die vollständige Entfernung der submakulären PKF wurde in allen Fällen (100%) erreicht, und es wurden keine mit der Behandlung verbundenen signifikanten Komplikationen beobachtet. Die mittlere Nachbeobachtungszeit betrug 37,60 ± 14,00 Monate (18 – 60) und die bestkorrigierte Sehschärfe war signifikant verbessert (p = 0,001). Am Ende der Nachbeobachtungszeit wurde bei 6 Patienten (40,00%) eine auffällige Störung der Ellipsoidzone beobachtet, während bei 9 Patienten (60,00%) keine auffällige Störung der Ellipsoidzone auftrat.

Schlussfolgerung Das chirurgische Verfahren zur submakulären PKF-Entfernung ist eine vernünftige Option und verbessert die Sehschärfe langfristig ohne signifikante behandlungsassoziierte Komplikationen.

Conclusion Box

Already known:

• An important complication associated with PFCL usage during PPV is its retention in the submacular area.

• In case of submacular PFCL retention, an additional surgery can be performed to prevent retinal pigment epithelium atrophy, photoreceptor damage, and macular hole formation.

• Retinotomy or small-gauge needle-assisted aspiration are some of the surgical techniques that have been described to provide PFCL removal; however, there is no widely accepted method and there remains many unknowns to refine the technique.

Newly described:

• The surgical procedural for submacular PFCL removal, including ILM peeling, transretinal removal of submacular PFCL with a 25/27-gauge cannula, and C₃F₈ used as an endotamponade, is a reasonable option and improves visual acuity in the long term without any significant treatment-associated complications.

Key words

complication - pars plana vitrectomy - perfluorocarbon liquid - retinal detachment - vitreoretinal surgery

Schlüsselwörter

Komplikation - Netzhautablösung - Pars-plana-Vitrektomie - Perfluorkohlenstoffflüssigkeit - vitreoretinale Chirurgie

Publication History

Received: 15 July 2022

Accepted: 18 October 2022

Article published online:
12 January 2023

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