Short-Term Intraocular Perfluorocarbon Tamponade to Induce Posterior Vitreous Detachment in Traumatic Retinal Detachment: A Novel Staged Technique.

PURPOSE: To describe a novel staged surgical approach using short-term intraocular perfluorocarbon liquid (PFCL) tamponade to facilitate spontaneous posterior vitreous detachment (PVD) formation in a case of traumatic retinal detachment (RD) with dense vitreoretinal adhesion.

METHODS

A 36-year-old male presented with light perception vision in the right eye two weeks after scleral repair of a ruptured globe caused by a projectile nail. B-scan ultrasonography showed dense vitreous and subretinal hemorrhage with a total open-funnel RD. A 25-gauge pars plana vitrectomy (PPV) was performed, revealing a total RD, subretinal hemorrhage and a strongly adherent posterior hyaloid that could not be safely detached. PFCL was used to flatten the retina, displace subretinal hemorrhage, and maintain the retina flattened. The patient was instructed to maintain a face-up position, and PFCL removal was planned 10 days later.

RESULTS

At the second surgery, the posterior hyaloid had spontaneously detached, allowing complete hyaloid removal and retinal reattachment with PPV, endolaser, and silicone oil tamponade. The retina remained attached under silicone oil which was removed 9 weeks later. At 9 months post silicone oil removal the retina remained attached and best-corrected visual acuity improved to 20/60.

CONCLUSION

Unlike previously described intraoperative PFCL-assisted methods to flatten the retina, this technique uses PFCL's density and surface tension to generate gentle shear forces over time, passively inducing PVD while maintaining macular attachment. This approach offers an alternative for complex traumatic RDs with dense vitreoretinal adhesion.