Retained subretinal perfluorocarbon liquid in microincision 23-gauge versus traditional 20-gauge vitrectomy for retinal detachment repair

Purpose: To assess the rate of retained subretinal perfluorocarbon liquid (PFCL) in patients undergoing rhegmatogenous retinal detachment (RRD) repair with sutureless 23-gauge vitrectomy versus traditional 20-gauge vitrectomy. Methods: A retrospective, consecutive, interventional comparative case series. All patients with a diagnosis of RRD who underwent pars plana vitrectomy with PFCL for RRD repair from November 1, 2005 through October 31, 2008 were included. Results: A total of 234 RRD repairs were performed during the study period by one surgeon. Subretinal PFCL occurred in 4 of 176 eyes (2.3%) who underwent sutured 20-gauge pars plana vitrectomy and in 6 of 58 eyes (10.3%) who underwent sutureless 23-gauge pars plana vitrectomy for repair of retinal detachment (P = 0.0167, Fisher exact test, 2-tailed). Conclusion: There is a statistically significant 4.5-fold increased incidence of retained subretinal PFCL in patients undergoing RRD repair with sutureless 23-gauge vitrectomy versus traditional 20-gauge vitrectomy. This may be because of higher fluid flow through open 23-gauge cannulas, which causes disruption of the PFCL surface tension resulting in formation of small PFCL bubbles that can enter the subretinal space. Reduction of fluid flow may help prevent this complication.