PROGRESS IN SURGERY

Subretinal perfluorocarbon liquid (PFCL) migration is a rare but serious complication associated with retinal detachment repair, primarily due to the potential for toxic effects of the liquid. Intraoperative removal is the ideal solution, but this can be difficult, and retained PFCL is easily missed, to be detected only later during follow-up visits.

“When you’re treating cases with giant retinal tear with slipped and rolled retina, it is essentially impossible to avoid subretinal perfluorocarbon liquid migration in every case. So I developed a technique that I believe can eliminate this problem while still achieving good surgical results,” reported Tatsushi Kaga MD, PhD, of Nagoya, Japan, at the 14th annual EURETINA Congress in London.

Using an endoscope and successively tilting the patient’s head and eye in order to control the movement of subretinal fluid, Dr Kaga demonstrated his method of flattening and unrolling the retina without the use of PFCL.

“In this manner, it’s really not so difficult to flatten the retina,” he explained.

Step 1 is to use a flute needle to drain as much of the subretinal fluid as possible. Employing the endoscope to maintain visualisation of the peripheral tear, the patient’s head and eye are tilted so that the tear is positioned at the lowest position of the eye (Step 2).

“The subretinal fluid moves down towards the inferior part of the eye and gathers around the retinal tear because of gravity and surface tension,” said Dr Kaga.

FLUTE NEEDLE

Dr Kaga showed an endoscopic video of Step 3, in which the retina is flattened using a silicone-covered flute needle, “as if being swept by a broom”, he said. This step can be repeated until the retina is flat.

Once the subretinal fluid has been removed to the surgeon’s satisfaction, the patient’s head and eye are tilted so that the peripheral tear is positioned higher in the eye. End laser retinal photocoagulation can then be performed (Step 4). This step is also performed using the endoscope for visualisation.

“The endoscope provides a highly magnified image, so you can perform the photocoagulation with great certainty,” he said. “Endoscopic techniques are different from microscopic techniques and are not easy to perform, even in the hands of skilled surgeons.”

Dr Kaga cautioned that there is a definite learning curve involved in the use of the endoscope. However, he believes the benefits are worth the effort. An endoscope
provides stable visibility during fluid-air exchange. The fundus can be seen in any position, even if the eye is highly tilted, and it’s possible to see from oblique angles
with magnification.

Tatsushi Kaga: kaga@chukyogroup.jp