Surgical management of traumatic retinal detachment with perfluorocarbon liquid. The Vitreon Study Group

Long-Term Use of a Temporary Keratoprosthesis and Perfluorocarbon in Traumatic Retinal Detachment Repair

Purpose

To present a technique for optimizing repair of traumatic retinal detachments (RDs).

Methods

A patient was followed in an outpatient setting with clinical examinations, optical coherence tomography, widefield fundus photography, and anterior segment imaging.

Results

The patient presented with a total RD after ruptured globe repair. The patient had combined corneal and retinal surgery with placement of a temporary keratoprosthesis (TKP) and vitrectomy with perfluorocarbon liquid (PFCL) to reattach the retina. The TKP and PFCL were left in the eye for 2 weeks before a planned silicone oil exchange and penetrating keratoplasty were performed. Four months postoperatively, the patient presented with a partially attached retina and improved vision.

Conclusions

In this case, a ruptured globe decompensated several months after primary repair. The prolonged use of the TKP allowed for optimal surgical visualization, enhanced office-based assessment, and limited endothelial cell loss of the donor corneal tissue.

Perfluorocarbon liquid-assisted intraocular foreign body removal

We describe the benefits of perfluoro-N-octane (PFO), a perfluorocarbon liquid, in the removal of nonmagnetic intraocular foreign bodies (IOFBs) from the macula and posterior segment. Two consecutive cases of posterior segment IOFB were reviewed. An 18-year-old male presented to the emergency room after a motor vehicle accident with a zone 1 open globe injury and large glass IOFB in the left eye. A 53-year-old male presented to the emergency room with a history of a 3-week delayed presentation of a zone 1 open globe injury from a nail to the right eye. He was found to have a metallic IOFB. In both cases, PFO was used to slide the nonmagnetic IOFBs outside of the macula for safer retrieval. PFO was also able to protect the posterior pole from IOFB drops during early attempts at removal. PFO can be a useful surgical adjunct to pars plana vitrectomy in the removal of certain nonmagnetic IOFBs.

Combined pars plana vitrectomy and artificial iris diaphragm implant after globe rupture

BACKGROUND

Retinal detachment (RD) associated with aniridia due to globe rupture (GR) is an uncommon condition with a severe prognosis. Surgical technique must address anterior and posterior segment issues secondary to the altered compartmentalization and increased risk for corneal toxicity. The purpose of this paper is to report a series of GR patients undergoing combined pars plana vitrectomy (PPV) and artificial iris diaphragm (AID) implant for the repair of RD associated to aniridia.

METHODS

The authors retrospectively reviewed 12 consecutive patients operated on by a single surgeon. Surgery consisted of a standard three-port PPV with extensive bimanual dissection of vitreous base and ciliary body membrane and combined AID implant. Office visits included Snellen visual acuity (VA), intraocular pressure measurement, biomicroscopy and indirect ophthalmoscopy. AID prosthesis included aniridic IOLs, Heimann's PMMA and silicone diaphragm.

RESULTS

Mean age was 53 years and mean follow-up was 19 months. At the end of follow-up, seven patients gained more than two lines (58.3%), two lost their vision (16.6%) and three were unchanged (25%). Seven patients (58.3%) had a VA better than 20/400 and one (8%) 20/40 vision. Eight patients (66.6%) retained a clear cornea, two (16.6%) had minimal corneal oedema and two (16.6%) corneal decompensation. Implanted prosthesis included two silicone diaphragms, four PMMA diaphragms and six aniridic IOLs. After an average 1.6 operations, the retina was completely attached in six patients (50%), partially attached in four (33.3%) and detached in two (16.6%).

CONCLUSION

RD associated to GR carries a guarded prognosis both due to RD complexity and hypotony. The combined repair of RD and aniridia after GR offers the advantage of addressing all issues at one time allowing correct eye compartmentalization and better tamponade effect. Successful anatomical and functional results can be achieved although multiple surgeries are often needed.

Management of traumatic retinal detachment with vitreon in children

PURPOSE

To report the use of perfluoroperhydrophenanthrene (vitreon) for traumatic retinal detachment in children.

METHODS

Vitreon was used as an intraoperative adjunct in 34 children with complicated retinal detachment secondary to penetrating and perforating trauma. The characteristics of the injuries, the final visual acuities, the postoperative complications and the rate of anatomic success were evaluated in a retrospective study.

RESULTS

Patients were followed-up an average of 20 months. Eighteen retinas (53%) were reattached, and the postoperative visual acuity was counting fingers or better in 9 cases (26%), and only 4 eyes saw better than 10/200 at last follow-up. Hypotony developed in 7 (21%) of 34 eyes.

CONCLUSION

Management of traumatic retinal detachment in children is difficult. Vitreon, as other perfluorocarbons, may be an effective intraoperative tool for vitreoretinal surgery in pediatric eyes that suffer trauma.