Retina Surgery Feature Story

SEPTEMBER 2010 I RETINA TODAY I 71 C onventional vitreoretinal surgery uses three pars plana sclerotomies.1 During the procedure vitreous gel is removed and the intraocular volume is replaced for balanced salt solution perfusion.2 Perfluorocarbon liquids consist of a hydrocarbon molecule in which hydrogen atoms are replaced by fluorine atoms. Since 1987, Chang et al3 have recommended the use of perfluorocarbon liquid as a surgical tool for the management of complex retinal detachments because of it’s unique physical and biochemical characteristics. In 1995, Le Mer4 reported the use of perfluorocarbon as an adjunct in surgery for severe proliferative diabetic retinopathy (PDR) defined as tractional retinal detachment with or without vitreous hemorrhage. Itoh5 described the utility of perfluorocarbon in retinal detachment secondary to diabetic retinopathy as it enabled easy flattening of the posterior retinal folds and effective endophotocoagulation with good visual conditions. Imamura evaluated the value of using perfluorocarbon as adjuvant during vitrectomy in eyes with proliferative diabetic retinopathy. Perfluorocarbon permitted easier flattening of the retina in cases of bullous retinal detachment that developed when a tight vitreoretinal adhesion was loosened; and in cases with combined traction rhegmatogenous retinal detachment, perfluorocarbon was used to tamponade the detached retina which then allowed successful membrane dissection.6 Hugo Quiroz-Mercado, MD, described in 20047 and 20058 the perfluorocarbon-perfused vitrectomy as a new technique to remove vitreous in an animal model and during vitrectomy for patients with proliferative diabetic retinopathy and rhegmatogenous retinal detachment. Experience to date suggests that perfluorocarbon-perfused vitrectomy is a safe and feasible technique for removal vitreous with several advantages over balanced salt solution due to its relative density, immiscibility with blood and ocular fluids, and ability to transport oxygen. Modifications in vitrectomy instrumentation have attempted to decrease surgical time and reduce intra and postoperative complications so as to provide the best anatomical and functional outcome. We would like to describe Dr. Quiroz-Mercado’s perfluorocarbon-perfused vitrectomy original idea in order to treat patients with severe PDR.