Perfluorocarbon liquid-assisted vitreo-dissection in eyes with firmly adherent posterior hyaloid

Abstract

Background: Induction of posterior vitreous detachment (PVD) is a critical step during pars plana vitrectomy. Multiple techniques and utilities have been proposed for assistance with this step with no consensus on the safest and most effective means, especially in eyes with firmly adherent posterior hyaloid. Viscodissection or the utilization of perfluorocarbon liquid (PFCL) can be used to dissect the posterior hyaloid and widely adherent epiretinal membranes.

Methods: A technique of PFCL dissection of the posterior hyaloid in eyes with abnormal adhesion of the posterior hyaloid. After core vitrectomy, breaking into the posterior hyaloid face is made via active aspiration and cutting or a sharp dissection. This is followed by active and slow injection of PFCL into the potential space between the posterior cortical vitreous and the neurosensory retina. A wave of PFCL propagates anteriorly causing "vitreo-dissection" of the peripheral cortical vitreous.

Results: The technique was effective and safe in 8 successive cases, 4 cases with vitreoretinal traction syndrome and 4 with diabetic tractional membranes.

Conclusion: The technique can be considered in cases with abnormal firmly adherent posterior hyaloid when induction of PVD proves difficult.

Keywords: PFCL; Pars Plana Vitrectomy; Perfluorocarbon liquid; Posterior vitreous detachment; Vitreo-dissection.

Fig. 1

Vitreo-dissection technique using PFCL. Initial creation of a hole within the posterior hyaloid using active aspiration and cutting by the vitrectomy probe (A), followed by introduction of the PFCL cannula into the hole directed towards the potential space between the posterior cortical vitreous and the neurosensory retina (B), and injection of PFCL to form a bubble that propagates, elevating the posterior cortical vitreous away from the retina (C)