Management of persistent loculated subretinal fluid after pneumatic retinopexy

To report on the incidence and management of a unique and troublesome complication of pneumatic retinopexy-localised, delayed subretinal fluid absorption (DSRFA).

A retrospective chart review was done for all patients who underwent pneumatic retinopexy for retinal detachment over a 5 year period to identify the patients with DSRFA.

Seven phakic patients (five females, two males, age range 26-87 years) were identified with the phenomenon of delayed resolution of subretinal fluid after pneumatic retinopexy and cryotherapy. In four patients the subretinal fluid involved the macula. Time taken to complete absorption of the subretinal fluid ranged from 10 to 26 months. In one patient there was still residual fluid inferiorly at 18 months of follow up. During the follow up period additional procedures were performed--scleral buckling (five eyes), pars plana vitrectomy (one eye), and mild laser scatter to extramacular areas of shallow subretinal fluid (four eyes). None of these procedures appeared to influence the rate of fluid absorption.

Loculated subretinal fluid following pneumatic retinopexy may persist for very long periods, extending up to more than 2 years. Additional surgical procedures or laser photocoagulation do not affect the rate of subretinal fluid absorption. Spontaneous reattachment eventually occurs in most eyes, and conservative management is indicated.