Soft shell technique during vitrectomy for proliferative vitreoretinopathy.
OBJECTIVE
To determine whether ophthalmic viscoelastic devices (OVDs) can be used during vitrectomy to prevent perflorocarbon liquid (PFCL) from leaking into the subretinal space through retinal tears in eyes with proliferative vitreoretinopathy (PVR). The OVDs are adhesive materials that can temporally close retinal breaks. We introduce a "soft shell technique", which allows the unfolding of the retina by PFCL.


METHODS
We studied five eyes of five patients with proliferative vitreoretinopathy that underwent vitrectomy using the soft shell technique. After removing the core vitreous, the OVDs were carefully injected over the area where confluent retinal folds were formed with possible retinal breaks. This created a soft shell shield on the retina that can prevent the intravitreal PFCL from leaking into the subretinal space.


RESULTS
The soft shell technique still allowed the PFCL to unfold the retina even if iatrogenic breaks are present. The high viscosity of OVDs sealed the iatrogenic retinal breaks and thus prevented the PFCL from leaking into the subretinal space during the vitrectomy. All patients had an improvement of the visual acuity, and four eyes had a reattachment of the retina.


CONCLUSIONS
Although only five eyes were examined, the success of the soft shell technique indicates that it can be used with PFCL, which facilitates the unfolding of the contracted retina.
Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Keita
K
Yamakiri
Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Eisuke
E
Uchino
Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. tsakamot@m3.kufm.kagoshima-u.ac.jp.
Taiji
T
Sakamoto
D000328:Adult; D000368:Aged; D002809:Chondroitin Sulfates / Q000008:administration & dosage; D004322:Drainage / Q000379:methods; D004338:Drug Combinations; D005466:Fluorocarbons / Q000008:administration & dosage*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000601:surgery*; D012827:Silicone Oils; D055675:Viscosupplements / Q000008:administration & dosage*; D014821:Vitrectomy / Q000379:methods*; D018630:Vitreoretinopathy, Proliferative / Q000601:surgery*
D004338:Drug Combinations; D005466:Fluorocarbons; D012827:Silicone Oils; D055675:Viscosupplements; C501944:chondroitin sulfate, sodium hyaluronate drug combination; D006820:Hyaluronic Acid; D002809:Chondroitin Sulfates
Adjuvant; Hyaluronan; Proliferative vitreoretinopathy; Retinal detachment; Silicone oil; Subretinal strand; Trauma