Natural speed thanks ; it is a video prompt for an ophthalmology journal (US journal).
We present subretinal foveal PFCL micro droplets removal without intraoperative optical coherence tomography using 41-gauge canula and PFCL maneuvers.
The baseline Visual Acuity was 20/63 following a single vitrectomy cryopexy gas to repair a rhegmatogenous retinal detachment on a 52 year-old pseudophakic man.
We did an ILM peeling in the foveolar area to relax the neuroretina and attempt to help mobilizing the PFCL micro droplets.
We cannulated gently BSS with entry point along inferior temporal arcade about 1500 microns in lower nasal zone from the foveola. We injected enough BSS to go beyond foveola, not to create a macular fold, and be sure to mobilize the different subretinal PFCL micro droplets.
We used silicone tip of the backflush cannula to feel detached neuroretina around foveola. The PFCL droplets were stuck on RPE level and not in neuroretina.
We injected gently, in one large bubble, 1.5cc of PFCL facing the optical nerve. The aim was to mobilize PFCL subretinal droplets thanks to retinal massage induced by sub retinal BSS and supra retinal PFCL.
We released a supra-retinal bubble PFCL over fovea and inside the PFCL (so "bubble in bubble" technique), to flatten and check subretinal PFCL droplets complete removal without intraoperative OCT.
These PFCL maneuvers helped to remove subretinal PFCL without direct aspiration, due to Laplace pressure.
Complete PFCL aspiration with 25 gauge backflush silicon tip was done.
We made partial fluid-air exchange 80% then SF6 20% to allow the other subretinal extrafoveal microdroplets to migrate downwards beyond the equator postoperatively, with the patient's face down positioning.
Remodeling at the entry point of 41 gauge cannula of the outer nuclear layer was observed without alteration of the photoreceptor layer.
Satisfactory structural and functional results were observed thanks to this technique without intraoperative OCT using 41 gauge cannula and PFCL maneuvers.
