Postoperative perfluoro-n-octane tamponade for primary retinal detachment repair

AIM: To study outcomes after using perfluoro-n-octane (PFO) as a short-term postoperative vitreous substitute in eyes undergoing primary vitrectomy with or without scleral buckling for rhegmatogenous retinal detachments with inferior/multiple breaks or giant retinal tears (GRTs). METHODS: Charts of 39 eyes at 3-24 months after primary PFO retention and secondary replacement were retrospectively analyzed for anatomical attachment rates, visual acuity gain, and postoperative complications. RESULTS: Intraoperatively, 33 of 39 eyes showed ≥4 retinal breaks, with 31 of 39 eyes having at least 1 inferior break, 10 of 39 eyes having GRT, and 12 of 39 eyes showing preoperative proliferative vitreoretinopathy. All eyes showed complete anatomical retinal attachment after primary vitrectomy for at least 7-17 days when PFO was retained without any specific posturing. With sulfur hexafluoride (SF ₆) gas PFO exchange, 3 cases redetached. With perfluoropropane (C ₃F ₈) gas or silicone oil PFO exchange, no cases redetached, resulting in a final anatomical success rate of 92.4%. Visual acuity improved from 2.07 ± 0.86 to 0.76 ± 0.79 logarithm of the minimum angle of resolution (P < 0.0004) among macula-off and from 0.11 ±0.08 to 0.12 ± 0.09 logarithm of the minimum angle of resolution (P > 0.05) among macula-on rhegmatogenous retinal detachment eyes. Perfluoro-n-octane retention ≥10 days significantly increased posterior capsular opacification (28 of 39 eyes) and cataract extraction rates (21 of 25 eyes) without affecting the final retinal attachment success rate. CONCLUSION: Perfluoro-n-octane is efficacious and safe as a short-term vitreous substitute in primary rhegmatogenous retinal detachment repair cases with inferior/multiple breaks or GRTs. Perfluoro-n-octane removal within 10 days reduces its side effect profile considerably. The highest anatomical retinal reattachment rates were observed when C ₃F ₈ or silicone oil was exchanged for PFO.