REMOVAL OF SUBRETINAL GAS AFTER PNEUMATIC RETINOPEXY UNDER AIR USING EXTERNAL MANIPULATION

To illustrate a technique for the removal of subretinal gas through pars plana vitrectomy with air-fluid exchange and simultaneous manipulation with scleral depression.

Pars plana vitrectomy to remove subretinal gas causing persistent macula-off retinal detachment was performed in one eye, and the results were evaluated in this case report. Ports were carefully placed to avoid puncturing the retina, which was significantly displaced anteriorly past the ora serrata because of the buoyancy of the subretinal gas with the patient in a supine position. After vitrectomy was performed, an air-fluid exchange was initiated to flatten the anterior retina and assist in stabilizing the subretinal gas bubble. Simultaneously, a scleral depressor was used to apply external pressure in a sweeping motion to direct the subretinal gas toward the pre-existing retinal break where it was aspirated or moved into the vitreous cavity.

The 1-year postoperative visual acuity without correction was 20/25 with normal intraocular pressure and attached retina. There were no intraoperative or postoperative complications.

Our technique used a partial air-fluid exchange to stabilize the subretinal gas and external manipulation with a scleral depressor to manually extrude subretinal gas. This maneuver was previously described in the 1980s, and we include a surgical video of its execution with modern vitrectomy equipment and the benefit of excellent control of the subretinal gas without the need to create a retinotomy.