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Subfoveal perfluorocarbon liquid. Removal after three months
Perfluorocarbono líquido subfoveal. Extracción después de 3 meses
M.A. Sierra-Rodrígueza,
Corresponding author
sffera@hotmail.com

Corresponding author.
, J.M. López-Lópezb, S. Jiménez-Prada de Miguelb
a Servicio de Oftalmología, Hospital Comarcal de Benavente, Benavente, Zamora, Spain
b Servicio de Oftalmología, Hospital del Río Hortega, Valladolid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Liquid perfluorocarbon &#40;LPFC&#41; is broadly used in vitreoretinal surgery&#46; However&#44; the manipulation of LPFC could give rise to complications&#46; Subretinal LPFC migration has been described with a frequency ranging between 0&#46;9 and 11&#46;1&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> which could be greater when retinal tear tractions are not released and in patients undergoing 23<span class="elsevierStyleHsp" style=""></span>g vitrectomy against conventional 20<span class="elsevierStyleHsp" style=""></span>g vitrectomy<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> due to the formation of multiple small bubbles&#46; 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surgical treatment was performed&#44; placing a 2&#46;5<span class="elsevierStyleHsp" style=""></span>mm cerclage and carrying out 20<span class="elsevierStyleHsp" style=""></span>g pars plana vitrectomy&#44; draining subretinal fluid with LPFC&#44; laser endophotocoagulation of retinal tears and liquid&#8211;gas exchange with 15&#37; octofluoropropane &#40;C3F8&#41; as the retinal tears were located at 4 o&#8217;clock&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Prior to complete reabsorption of said gas&#44; the patient referred poor vision and central scotoma&#46; Ocular fundus revealed a LPFC subfoveal bubble of approximately 750<span class="elsevierStyleHsp" style=""></span>&#956;m as well as other smaller bubbles located in the subretinal space at the level of the papillomacular bundle &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Three months later&#44; a new 20<span class="elsevierStyleHsp" style=""></span>g pars plana vitrectomy was performed for removing the subfoveal LPFC bubbles&#46; Endolaser retinotomy was performed close to the upper temporal arch&#44; through which a 41<span class="elsevierStyleHsp" style=""></span>g cannula was inserted in the subretinal space&#44; coupled to a syringe and a silicone injection system connected to the vitreotome&#44; substituting silicone by BSS&#46; A small amount of BSS was slowly injected in the subretinal space to achieve a therapeutic macular retinal detachment to facilitate the absorption of the LPFC subfoveal bubble&#44; with subsequent exchange of air &#8211; 20&#37; sulfur hexafluoride &#40;SF6&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the immediate postop&#44; the retina was reapplied without subfoveal LPFC&#46; However&#44; optical coherence tomography &#40;OCT&#41; taken one month after surgery revealed a post-surgery cystic macular edema &#40;CME&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; treated administering 3 monthly transseptal triamcinolone injections which achieved partial edema resolution&#46; On the basis of this result&#44; a fourth intravitreal injection was administered which achieved a normal macular profile &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#44; maintained at this date &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#44; with best corrected visual acuity of 0&#46;3&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Despite subfoveal LPFC retention being an infrequent complication of vitreoretinal surgery in accordance with the few published cases&#44;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;9</span></a> it is an important and potentially severe complication&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The time elapsed since the extraction of the subfoveal LPFC appears to influence the final visual acuity as the retention of subretinal LPFC has a potentially toxic effect on the retina pigment epithelium &#40;RPE&#41;&#44; and in long-term progressive photoreceptor atrophy&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;6&#44;9</span></a> Some authors consider said extraction to be safe and efficient&#44; with very low or no toxicity if performed before 3 months&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> In the present case&#44; the authors believe that the ophthalmoscopic and tomographic results as well as the final visual acuity have been very positive because useful vision was achieved despite significant poor prognostic factors&#44; i&#46;e&#46;&#44; complete retina detachment in an elderly patient&#44; post-surgery CME which took 4 months to resolve&#44; and an LPFC bubbles which remained 3 months in the subretinal space&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A further aspect to be taken into account is the risk of producing iatrogenic injuries during extraction&#44; such as direct traumatism with the suction cannula which could produce macular hole&#44; submacular hemorrhage&#44; retinotomy enlargement and photoreceptor lesions with irreversible visual damages&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; it is possible to achieve a useful final visual acuity in patients with the complications described above despite poor prognostic factors&#44; provided that the fovea is not damaged and maneuvers that could damage the macula are avoided during the extraction of the LPFC bubble&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors&#46;</p></span></span>"
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    "fechaRecibido" => "2015-11-24"
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            0 => "Perfluorocarbon liquid"
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            0 => "Perfluorocarbono l&#237;quido"
            1 => "Subfoveal"
            2 => "Vitrectom&#237;a"
            3 => "M&#225;cula"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Clinical case</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A case of surgical removal of a subfoveal perfluorocarbon liquid &#40;PFCL&#41; bubble that remained trapped inside the subretinal space&#46; PFCL bubble extraction was performed by performing a therapeutic and vacuum PFCL bubble macular retinal detachment&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The elapsed time before subfoveal PFCL extraction seems to influence the visual result&#46; There are other factors which could influence the final visual acuity significantly&#44; nevertheless it is possible to achieve useful vision&#44; as long as the fovea is not damaged and iatrogenic injuries are avoided during PFCL bubble extraction&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Sierra-Rodr&#237;guez MA&#44; L&#243;pez-L&#243;pez JM&#44; Jim&#233;nez-Prada de Miguel S&#46; Perfluorocarbono l&#237;quido subfoveal&#46; Extracci&#243;n despu&#233;s de 3 meses&#46; Arch Soc Esp Oftalmol&#46; 2016&#59;91&#58;589&#8211;591&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ophthalmoscopic image&#44; right eye&#44; showing subfoveal LPFC bubble &#40;approximately 750<span class="elsevierStyleHsp" style=""></span>&#956;m&#41; and other smaller bubbles in the papillomacular bundle&#46;</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">OCT image of <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; clearly illustrating subretinal LPFC bubbles&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">OCT image one month after surgery&#44; showing postop CME&#46;</p>"
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      "seccion" => array:1 [
        0 => array:2 [
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          "bibliografiaReferencia" => array:9 [
            0 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Displacement of retained subfoveal perfluorocarbon liquid after vitreoretinal surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Le Tien"
                            1 => "V&#46; Pierre-Kahn"
                            2 => "F&#46; Azan"
                            3 => "G&#46; Renard"
                            4 => "D&#46; Chauvaud"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archophthalmol.2007.2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Ophthalmol"
                        "fecha" => "2008"
                        "volumen" => "126"
                        "paginaInicial" => "98"
                        "paginaFinal" => "101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18195225"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retained subretinal perfluorocarbon liquid in microincision 23-gauge versus traditional 20-gauge vitrectomy for retinal detachment repair"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;J&#46; Garg"
                            1 => "A&#46;B&#46; Theventhiran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IAE.0b013e31825540ee"
                      "Revista" => array:6 [
                        "tituloSerie" => "Retina"
                        "fecha" => "2012"
                        "volumen" => "32"
                        "paginaInicial" => "2127"
                        "paginaFinal" => "2132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22534581"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recovery of visual function after removal of chronic subfoveal perfluorocarbon liquid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;C&#46; Lai"
                            1 => "E&#46;A&#46; Postel"
                            2 => "B&#46;W&#46; McCuen 2nd"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Retina"
                        "fecha" => "2003"
                        "volumen" => "23"
                        "paginaInicial" => "868"
                        "paginaFinal" => "870"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14707843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subfoveal liquid perfluorocarbon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Lesnoni"
                            1 => "T&#46; Rossi"
                            2 => "A&#46; Gelso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Retina"
                        "fecha" => "2004"
                        "volumen" => "24"
                        "paginaInicial" => "172"
                        "paginaFinal" => "176"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15076967"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Removal of retained subfoveal perfluoro-n-octane liquid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;B&#46; Roth"
                            1 => "J&#46;E&#46; Sears"
                            2 => "H&#46; Lewis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajo.2004.02.077"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Ophthalmol"
                        "fecha" => "2004"
                        "volumen" => "138"
                        "paginaInicial" => "287"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15289141"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Removal of retained subretinal perfluorocarbon liquid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Garc&#237;a-Arum&#237;"
                            1 => "P&#46; Castillo"
                            2 => "M&#46; L&#243;pez"
                            3 => "A&#46; Boixadera"
                            4 => "V&#46; Mart&#237;nez-Castillo"
                            5 => "L&#46; Pimentel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjo.2007.129585"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Ophthalmol"
                        "fecha" => "2008"
                        "volumen" => "92"
                        "paginaInicial" => "1693"
                        "paginaFinal" => "1694"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19029164"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical removal of retained subfoveal perfluorocarbon liquid through a therapeutic macular hole with intravitreal PFCL injection and gas tamponade"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Kim"
                            1 => "S&#46;J&#46; Woo"
                            2 => "K&#46;H&#46; Park"
                            3 => "H&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3341/kjo.2013.27.5.392"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Ophthalmol"
                        "fecha" => "2013"
                        "volumen" => "27"
                        "paginaInicial" => "392"
                        "paginaFinal" => "395"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24082781"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;in Spanish&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subfoveal perfluorocarbon liquid two new cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Vilaplana"
                            1 => "V&#46; Poposki"
                            2 => "A&#46; Mart&#237;nez-Palmer"
                            3 => "M&#46; Castilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Soc Esp Oftalmol"
                        "fecha" => "2009"
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Article information
ISSN: 21735794
Original language: English
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