Problem:

Subfoveal PFCL is usually observed after vitrectomy for macula-off retinal detachment. As it causes photoreceptor cell damage and visual impairment, removal as early as possible is generally recommended. Most frequently, during repeat vitrectomy, a direct puncture of the bleb using a small-sized cannula (for example with a 40G teflon needle) is performed. H owever this manoeuvre implies the risk to damage the juxtafoveal retinal tissue and RPE (leading to a retinal scar or provoking a secondary CNV) or results in an incomplete removal.

Case Presentation:

My preferred technique is to inject BSS subretinally afar from the macula using a 40G tenon cannula, then mobilising the PFCL bubble gently with a soft tip and finally aspirating the bubble via the retinotomy done for the BSS-injection. Even in case the drainage is not a 100% complete, small remnants will be displaced to the peripheral margin of the BSS-bleb, because the procedure is completed with an air/gas tamponade and upright positioning.

Outcomes:

Postoperatively, no subfoveal PFCL remnants were detected. Function depends on the preexisting foveal damage (macula-off detachment, PFCL-photoreceptor toxicity). OCT has turned out to be a valuable diagnostic tool to evaluate possible structural changes.

Take Home Message:

Displacement of a subfoveal PFCL-bubble from the macular area using subretinal BSS-injection which is followed by PFCL-removal away from the macula is safe method. It prevents direct tissue manipulations in the macular area. Attention must be paid to inject BSS very slowly to avoid a fluid pop through the fovea and a macular hole.

Contact Details:

Email: s.bopp@retina.to
Cell Phone: /+491724102301