Oman Journal of Ophthalmology

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

Epiretinal membrane development after submacular perfluorocarbon liquid removal


Parijat Chandra, Vinod Kumar, Brijesh Takkar, Atul Kumar 
 Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Brijesh Takkar
Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room 485, New Delhi - 110 029
India

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.



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;10:253-254


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 2019 Aug 20 ];10:253-254
Available from: http://www.ojoonline.org/text.asp?2017/10/3/253/216007


Full Text

 Introduction



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



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}

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



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

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