Management of complex retinal detachment with combined relaxing retinotomy and intravitreal perfluoro-n-octane injection

We evaluated intravitreal perfluoro-n-octane injection for the positioning of large retinal flaps after relaxing retinotomies. Nineteen eyes underwent vitrectomy for advanced retinal detachments from proliferative vitreoretinopathy (11 eyes), trauma (five eyes), and proliferative diabetic retinopathy (three eyes). After retinotomy and complete relief of traction, injection of perfluoro-n-octane to a level anterior to the retinotomy edge was used to remove subretinal fluid thoroughly from beneath the retinal flap. All irrigation fluid anterior to the perfluoro-n-octane meniscus was aspirated before perfluoro-n-octane removal. Final tamponade was obtained with gas (four eyes) or silicone oil (15 eyes). After six to 17 months of follow-up, the retinas were attached in 13 eyes (68%), and visual acuity of 5/200 or better was obtained in eight eyes (42%). Subretinal migration of perfluoro-n-octane and posterior slippage of the retinal flap occurred during perfluoro-n-octane/silicone oil exchange in one eye. No other complications were detected. Perfluoro-n-octane injection is an effective technique for positioning large retinal flaps after relaxing retinotomy.