Bimanual 25-gauge chandelier technique for direct perfluorocarbon liquid-silicone oil exchange in retinal detachments associated with giant retinal tear

Hybrid 23/25-Gauge Direct Perfluorocarbon Liquid-Silicone Oil Exchange

PURPOSE

To describe a novel technique for direct perfluorocarbon liquid (PFCL)-silicone oil exchange that aims to reduce the inherent risk of intraoperative intraocular pressure spike.

METHODS

We use the conventional setup for passive PFCL-silicone exchange, but intentionally create a mismatch between the passive PFCL aspiration and the active silicone injection that favors the PFCL extrusion. This is achieved by converting one port to a large gauge one-23 or 20-gauge.

RESULTS

We did not note the occurrence of high intraocular pressure spikes with this technique as noted by disk pallor or attenuated vessels.

CONCLUSION

A hybrid 23/25-gauge technique for direct PFCL-silicone oil exchange is safe and reduces the risk of intraoperative intraocular pressure spike.

Fully Automated Direct Perfluorocarbon Liquid-Silicone Oil Exchange

Purpose

To demonstrate a modified technique of fully automated direct perfluorocarbon liquid (PFCL)-silicone oil (SO) exchange.

Materials and Methods

This technique is indicated for cases that require direct PFCL-SO exchange as in giant retinal tear or large retinectomies to avoid retinal slippage. Pars plana vitrectomy (PPV) is carried out in standard fashion; then the dual active injection/extrusion mode is activated in the vitrectomy machine. The machine parameters are set at approximately 30–40 psi for SO injection and 150–250 mmHg for active PFCL aspiration. In this method, both the SO injection and the PFCL extrusion are simultaneously controlled by the foot pedal.

Results

We used this technique for a total of 24 cases: 6 cases of giant retinal tears and 18 retinectomies. We did not encounter any complications related to significant IOP spike during surgery or complete removal of the PFCL.

Conclusion

This automated technique for direct PFCL-SO exchange maintains a controlled balance between SO injection and PFCL aspiration, that mitigates the risk of intraoperative IOP spikes. It is safe, quick, and can be performed without the need of an assistant or extra chandelier light or high-pressure viscous tubing.