Surgeon uses medium-term perfluoro-n-octane without a scleral buckle for inferior, nasal, and temporal giant breaks as well as inferior retinal detachments.
This article was reviewed by Steve Charles, MD
Medium-term perfluo-N-octane (PFO) without a scleral buckle is the preferred treatment of Steve Charles, MD, for inferior, nasal and temporal giant breaks as well as inferior retinal detachments. He uses the PFO after vitrectomy as a tamponade and leaves it in place in eyes completely filled with the substance for 14 days.
According to Dr. Charles, clinical professor ophthalmology, University of Tennessee, Memphis, this approach, which he has used in excess of 1,000 cases over almost 20 years, eliminates the need for postoperative prone or face-down positioning and does not limit the patients’ activities or positioning such as is associated with the use of gas bubbles as a tamponade.
“I use this for inferior detachments and not for detachments above the horizontal meridian,” he said. “Without the use of scleral buckles, no myopia or strabismus is induced, and there is no pain, ocular surface disorder such as poor conjunctival closure, or corneal damage. This treatment is ideal in phakic and in those with intraocular lenses.”
He also discounted the notion that this tamponade is associated with toxicity.
“In my series of eyes, I have seen no evidence of toxicity associated with the Alcon product which is used off-label,” he stated.
When performing peripheral vitrectomy to repair inferior detachments, Dr. Charles emphasized the importance of removing residual vitreous at the top of the bubble.
“Surgeons must be meticulous about removing vitreous at the point at which the top of the bubble interacts with the superior retina,” he explained. “Don’t be casual about scleral depression and wide-angle visualization to remove superior vitreous.”
Dr. Charles injects PFO, which was developed by Stanley Chang, MD, to treat giant breaks, using a dual-bore cannula (MedOne Surgical Inc.).
He advises using the following procedure: Keep the tip of the cannula in contact with the initial bubble made over the optic nerve head, carefully focus and follow that bubble upwards as it expands.
“If method is used, a single bubble will result,” he said. “If multiple small bubbles are created, the chances are higher of one of them going through the break and into the subfoveal space.”
Regarding treating retinal breaks with laser, Dr. Charles has always used confluent laser around the breaks.
“You should never apply multiple rows of spots because of the potential for creation of under lapping, over lapping and larger peripheral field defects,” he said.
Dr. Charles also advises draining subretinal fluid if it persists after PFO is injected.
“If the break is carefully cannulated, the subretinal fluid drainage can be initiated,” he said. “Internal drainage techniques can still be used even in the presence of PFO."