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 Table of Contents    
CLINICAL IMAGE
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 253-254  

Epiretinal membrane development after submacular perfluorocarbon liquid removal


Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication5-Oct-2017

Correspondence Address:
Brijesh Takkar
Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room 485, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_39_2015

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   Abstract 

Optical coherence tomography of submacular perfluorocarbon liquid and its safe removal with a small gauge cannula have been presented in the report. This case was complicated by development of an epiretinal membrane, though visual acuity was preserved.

Keywords: Epiretinal membrane, perfluorocarbon liquid, subretinal perfluorocarbon liquid


How to cite this article:
Chandra P, Kumar V, Takkar B, Kumar A. Epiretinal membrane development after submacular perfluorocarbon liquid removal. Oman J Ophthalmol 2017;10:253-4

How to cite this URL:
Chandra P, Kumar V, Takkar B, Kumar A. Epiretinal membrane development after submacular perfluorocarbon liquid removal. Oman J Ophthalmol [serial online] 2017 [cited 2017 Dec 15];10:253-4. Available from: http://www.ojoonline.org/text.asp?2017/10/3/253/216007


   Introduction Top


Submacular perfluorocarbon liquid (PFCL) can lead to functional visual loss, central scotoma and irreversible retinal structural damage.[1] We discuss optical coherence tomography (OCT) features of submacular PFCL and its management using small-gauge aspiration needle.


   Case Report Top


A 24-year-old male with posttraumatic inferior retinal detachment in the right eye underwent 25G vitreoretinal surgery with the use of PFCL and silicone oil tamponade. The left eye was normal. Visual acuity improved from counting fingers close to face to 5/60 after 2 weeks. Although retina was well attached, a dome-shaped elevation was noted beneath fovea suggestive of submacular PFCL [Figure 1]a. OCT revealed a well-defined cyst-like hyporeflective lesion in the subfoveal space with a central macular thickness of 919 μ. The retina above the cystic lesion was thinned out [Figure 1]b.
Figure 1: (a) Fundus photograph of the right eye showing attached retina under silicone oil and submacular perfluorocarbon liquid bubble (white arrow). A retinotomy scar is also seen superiorly above the temporal arcade (black arrow). (b) Optical coherence tomography image of the right eye showing perfluorocarbon liquid bubble in the subretinal space with overlying retinal thinning (white arrow). (c) Fundus photograph 6 weeks after aspiration of perfluorocarbon liquid bubble showing epimacular membrane and attached retina (white arrow). (d) Optical coherence tomography image after aspiration of perfluorocarbon liquid bubble showing the macular epiretinal membrane with absent foveal contour, gross distortion of outer retinal layers, and discontinuous inner segments-outer segments junction

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Another 25G vitreoretinal surgery was done for submacular PFCL removal. After silicone oil removal, retina was punctured at the inferotemporal margin of the subretinal PFCL bubble using a 25G needle with 41G flexible tip and the PFCL aspirated. The remnant PFCL bubble was removed using active suction with a 25G cannula. 14% C3F8 gas was injected after fluid air exchange.

After 6 weeks, vision had improved to 6/12. The retina was well attached, but an epiretinal membrane (ERM) had developed over the fovea [Figure 1]c. The foveal contour was found to be absent on OCT with gross distortion of outer retinal layers and discontinuous inner segments-outer segments junction [Figure 1]d. Follow-up was advised in view of good vision and no metamorphopsia.


   Discussion Top


PFCL enters the subretinal space through retinal breaks/posterior retinotomy during surgery. Quick removal of submacular PFCL is advocated as visual prognosis depends on duration of its contact with retinal structures.[1] Displacement of submacular PFCL to peripheral retina may be done using gas or other positioning techniques,[2] however, such maneuvers work only in the early postoperative period.[3]

Complete removal can be achieved by direct aspiration through juxtafoveal retinotomy or therapeutic macular holes,[3] sometimes aided by inducing therapeutic retinal detachment,[4] followed by the use of small gauge cannulas or aspiration with microcannulas.[5] Good visual acuity and stable retinal architecture have been achieved with smaller therapeutic macular holes[3] but involves the risk of scotoma development. Creating a therapeutic retinal detachment is challenging and may be complicated by the occurrence of macular hole in the thin retina.[3],[4]

Small gauge cannula is a good instrument as it allows the creation of self-sealing puncture sites, allows induction of local retinal detachment if needed, and can aspirate PFCL bubbles easily. Thin retina over the PFCL bubble makes the puncture easy, and PFCL removal can be safely done with controlled infusion pressure and direct aspiration.

While other studies have reported macular hole, submacular hemorrhage, enlargement of the juxtafoveal retinotomy, or damage to the macular photoreceptor or RPE cells, and submacular fibrosis,[4] we observed the development of ERM postoperatively, which could be due to the perifoveal retinal puncture, aggravated by gas tamponade, and a predisposition in young patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Shulman M, Sepah YJ, Chang S, Abrams GW, Do DV, Nguyen QD. Management of retained subretinal perfluorocarbon liquid. Ophthalmic Surg Lasers Imaging Retina 2013;44:577-83.  Back to cited text no. 1
[PUBMED]    
2.
Konstantinidis L, Wolfensberger TJ. A novel technique for removal of inadvertent subretinal perfluorocarbon liquid after complex retinal detachment surgery. Eye (Lond) 2010;24:1109-11.  Back to cited text no. 2
[PUBMED]    
3.
Kim JM, Woo SJ, Park KH, Chung H. Surgical removal of retained subfoveal perfluorocarbon liquid through a therapeutic macular hole with intravitreal PFCL injection and gas tamponade. Korean J Ophthalmol 2013;27:392-5.  Back to cited text no. 3
[PUBMED]    
4.
Le Tien V, Pierre-Kahn V, Azan F, Renard G, Chauvaud D. Displacement of retained subfoveal perfluorocarbon liquid after vitreoretinal surgery. Arch Ophthalmol 2008;126:98-101.  Back to cited text no. 4
[PUBMED]    
5.
Joondeph BC. Controlled aspiration of subfoveal perfluorocarbon liquid using a novel microcannula. Retina 2011;31:991-3.  Back to cited text no. 5
[PUBMED]    


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