June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Quantitative assessment of venting techniques to facilitate intraocular perfluorocarbon removal
Author Affiliations & Notes
  • Hartej Singh
    Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, New Jersey, United States
  • Konstantin Astafurov
    Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, New Jersey, United States
  • Footnotes
    Commercial Relationships   Hartej Singh None; Konstantin Astafurov None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3407 – F0307. doi:
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      Hartej Singh, Konstantin Astafurov; Quantitative assessment of venting techniques to facilitate intraocular perfluorocarbon removal. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3407 – F0307.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose :
Perfluoro-n-octane (PFO) is a useful adjuvant for the repair of retinal detachments due to its transparency and high density. However, intraocular PFO retention has been implicated in inflammation, visual field defects, and retinal toxicity. Thus, the total removal of PFO at the end of surgery is critical but, at times, difficult due to corneal edema and intraocular lens fogging. PFO’s high vapor pressure in operating room conditions with continuous air venting aids its intraocular elimination. This study seeks to quantitatively characterize optimal conditions for the removal of residual PFO via evaporation during vitreoretinal surgery.

Methods : A standard, 25-gauge (25g) vitrectomy system (Alcon Constellation) and an anatomically-sized model plastic eye (Phillips Studio, UK) were used for the experimental setup. Valved trocars were placed 3.5mm from the corneal limbus, and low, clinically-relevant PFO volumes were instilled into the model eye. The evaporation rates were measured under varying venting conditions with humidified air infused at 40 mmHg by the Alcon Constellation. Four 25g venting methods were examined, a chimney-vent, a needle, and an extrusion cannula with and without a silicone tip. The needle and extrusion cannula trials were conducted at the mid-vitreous position and near the PFO interface.

Results : At the volumes tested, PFO evaporated linearly with all venting methods. The 25g chimney vent offered the fastest evaporation rate (0.019±0.002 cc/min). The 25g extrusion cannula with a silicone tip showed slower evaporation rates both at the mid-vitreous position and close to the PFO interface (0.006±0.0002 cc/min, 0.008±0.001 cc/min, respectively). Removing the extrusion cannula’s silicone tip marginally increased the evaporation rate (0.012±0.001 cc/min, near the PFO interface). The 25g needle yielded the slowest evaporation rate (0.005±0.0003 cc/min, near the PFO interface).

Conclusions : Residual PFO can be removed from the eye using air venting due to PFO’s high vapor pressure. We show that, with 25g instrumentation, a chimney-vent is the optimal PFO venting method, and, with air infused at 40 mmHg, five minutes are sufficient for eliminating PFO volumes up to 0.1 cc. Our quantitative data would be useful to vitreoretinal surgeons who may encounter challenges with visualization of complete PFO removal not infrequently seen at the end of long surgical procedures.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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