En bloc perfluorodissection can assist vitrectomy in eyes with tractional retinal detachment

En bloc perfluorodissection can be successfully used during vitrectomy in eyes with tractional retinal detachment in proliferative diabetic retinopathy, according to a prospective study published in the June issue of Ophthalmology.

"En bloc perfluorodissection seems to maintain the advantages of [perfluorocarbon-perfused vitrectomy], including retinal stability at the time of vitreous removal, better visualization of vitreous and intraocular structures, rapid retinal reattachment, less blood in the vitreous cavity, subretinal fluid resolution, blood confinement, and easier dissection of epiretinal membranes using [perfluorocarbon liquids] in a limited amount and with a simpler technique," the study author said.

J. Fernando Arevalo, MD, FACS, performed en bloc perfluorodissection (EBPD) during standard 20-gauge three-port pars plana vitrectomy on 57 eyes of 57 patients with tractional retinal detachment in severe proliferative diabetic retinopathy. Subsequently, all patients received complete eye examinations — including best corrected visual acuity, slit-lamp examination, IOP measurement and retinal stereoscopic biomicroscopy — over a minimum of 6 months, with an average of 18 months' follow-up.

During the EBPD procedure, perfluorocarbon liquid was injected between the retina and the posterior hyaloid to separate the epiretinal tissues from the underlying retina. Once all epiretinal tissues were separated, vitrectomy was completed, endolaser was used, and air-fluid and air-gas exchange was performed.

Surgical time averaged 50 minutes, ranging from 40 to 75 minutes; patients averaged 42 years of age.

During follow-up, none of the patients developed ocular hypertension or inflammation, Dr. Arevalo noted.

Of 57 total eyes, 40 eyes (70.1%) gained two or more ETDRS lines of BCVA, and all eyes achieved successful retinal reattachment.

BCVA remained stable in 14 eyes (24.5%) and decreased by two or more ETDRS lines in three eyes (5.2%).

Final BCVA of 20/50 or better was achieved in 25% of all eyes. BCVA between 20/60 and 20/400 was achieved in 47% of all eyes; BCVA worse than 20/400 was achieved in 28% of all eyes, Dr. Arevalo reported.

Complications included phthisis bulbi in one eye, iatrogenic retinal breaks in four eyes, vitreous hemorrhage requiring another procedure in four eyes and cataract in 15 eyes (26.3%), according to the study.