Janice C. Law, MD (Detroit, MI), Dean Eliott, MD (Los Angeles, CA)

PURPOSE:

The use of perfluorocarbon liquid (PFCL) has facilitated the treatment of complex retinal detachments. The purposes of this study were to evaluate the indications for PFCL use and the anatomic and functional outcome after PFCL use during pars plana vitrectomy for proliferative diabetic retinopathy.

METHODS:

Retrospective review of 520 consecutive diabetic vitrectomies done by one vitreoretinal surgeon at the Kresge Eye Institute. PFCL was used in 33 of these cases. Four eyes were excluded due to insufficient data, and five eyes were excluded from the final anatomic and functional outcome due to insufficient follow-up time (<6 months). Preoperative visual acuity, type of retinal detachment, and indication for PFCL were assessed. Final visual acuity and anatomic result at most recent follow-up visit were recorded.

RESULTS:

Of the 29 studied eyes, 16 underwent primary vitrectomy, while 13 were reoperations for recurrent retinal detachment. Primary vitrectomies were performed elsewhere in 5 of these 13 reoperations. PFCL was used in the most com plex cases, including eyes with extensive subretinal membranes, funnel configuration, retinal foreshortening, and anterior hyaloidal fibrovascular proliferation. Median preoperative visual acuity was hand motion (range, 20/200 to LP) for primary vitrectomies and LP (range, CF to LP) for reoperations. PFCL was used in eyes with peripheral retinal holes without posterior holes, and it was used in eyes that required extensive peripheral retinectomy. All 29 eyes achieved intraoperative anatomical flattening. Median postoperative visual acuity was LP; only 25% of patients were = 20/400, and 17% were = 20/50. Post-operative complications included neovascular glaucoma, pupillary block glaucoma, hypotony, band keratopathy, phthisis, and recurrent retinal detachment.

CONCLUSION:

In the vast majority of diabetic cases, PFCL use is not necessary. In our series, only the most severe cases (6.3%) required the use of PFCL to achieve in complex cases with a preexisting or iatrogenic peripheral retinal hole(s) in the absence of a posterior hole, and in cases that require extensive peripheral retinectomy.