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    Alternative Technique for Removal of Subfoveal Perfluorodecalin: Subretinal Air Bubble and Flex Loop

    AAO 2020 Video Program
    Retina/Vitreous, Vitreoretinal Surgery

    A 51-year-old man presented with huge subfoveal decalin after an uncomplicated retinal detachment surgery. After silicone oil removal, the macula was detached with balanced salt solution (BSS) using a 41-gauge subretinal canula. Since the bubble did not seem mobile, a flex loop was used to massage around the bubble to dislodge it to the periphery. After many attempts we thought that it was separated from the fovea, and perfluorodecalin was put onto the macula to provide dislocation of the bubble away from the fovea while we aspirated the fluid with a 41-gauge canula. However, it was obvious that the bubble was still under the fovea. This time we tried to inject some air bubbles with BSS into the submacular space to dissect the decalin from the structures around it. Finally it was free in the submacular space . After air-fluid exchange it was totally taken away from the subretinal space with active suction throughout a retinotomy located at the same place. Vision was 0.1 with some outer retinal disruptions in optical coherence tomography (OCT) at the first week. The vision was improved from 0.1 to 0.4, and OCT showed healing at the ellipsoid zone after six months. Air bubble and maneuvers with flex loop made the removal of very adherent decalin possible and provided good outcome in this case.