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Dustin Pomerleau, Mei Hong Tan, Jane Huan-Ling Lock, Timothy Isaacs, Ian McAllister; Outcomes of Sustained Perfluoro-n-octane Tamponade for Retinal Detachment Associated with Giant Retinal Tear. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1110. doi: https://doi.org/.
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To evaluate outcomes and potential complications of sustained tamponade with perfluoro-n-octane (PFO) in retinal detachment cases involving giant retinal tears (GRT).
168 charts from 2 centers were retrospectively reviewed, and cases involving sustained PFO tamponade were evaluated for inclusion. 26 eyes met inclusion criteria, with a primary diagnosis of rhegmatogenous retinal detachment, presence of a GRT (≥ 3 clock hours), and 12 months of follow-up. Treatment consisted of a primary vitrectomy, PFO tamponade and endolaser followed by post-operative predominantly supine positioning. Patients were evaluated at 1 week and 1, 3, 6, and 12 months. Primary treatment success was defined as anatomical attachment at 12 months without need for additional surgery after PFO removal.
Mean presenting visual acuity (VA) for patients with quantifiable vision was 0.40 logMAR, with 13 (50%) presenting macula-on and 13 (50%) presenting macula-off. 18 Eyes were phakic, 7 were pseudophakic and 1 was aphakic. 20 (77%) eyes had GRTs involving inferior quadrants, and 6 (23%) had superior GRTs not extending below the horizontal meridian. The surgical procedure was 20 gauge in 11 (42%) cases and 25 gauge in 15 (58%) cases, and was combined with encircling scleral buckle in 5 (19%) cases. PFO was left in-situ for a mean of 7 days (range 4-18 days). PFO was exchanged for SF6 in 17 (65%) eyes, C3F8 in 5 (19%) eyes, and silicone oil in 4 (15%) eyes. Over 12 months, the primary success rate was 85%, with 4 eyes requiring additional surgery for persistent/recurrent detachment. Mean VA at 1, 3, 6, and 12 months was 0.52, 0.48, 0.73, and 0.55 logMAR, respectively. Associated findings and adverse events included anterior chamber inflammation in 3 (12%) eyes, IOP elevation (> 22 mm Hg) in 6 (23%) eyes, epiretinal membrane sufficient to warrant surgery in 2 (8%) eyes, prolapse of PFO into the anterior chamber in 1 (4%) eye, and progression of nuclear sclerosis sufficient to warrant cataract surgery in 9 (35%) eyes. Subretinal PFO was not identified in any of the study eyes. There were no instances of retinal slippage.
Short-term (1-2 week) tamponade with PFO is an effective treatment strategy in retinal detachments associated with giant retinal tear. Careful patient selection and close follow-up are required to mitigate potential adverse events.
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