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Partial Fluid-Air Exchange Enhances Submacular Injection of Retinal Sheets
Grace Baldwin1,2, Yukari Akita3, Koichiro Manabe3,4
1Harvard Retinal Imaging Lab.
Ophthalmic Surgery, Lasers & Imaging Retina
|May 15, 2026
Summary
Partial fluid-air exchange (pFAX) reduces therapeutic loss during subretinal injections by minimizing reflux. This surgical technique enhances subretinal delivery of retinal sheets, improving outcomes in retinal surgery.
Area of Science:
- Ophthalmology
- Regenerative Medicine
- Surgical Innovation
Background:
- Subretinal therapeutics offer significant clinical potential.
- Therapeutic loss due to reflux into the vitreous is a major surgical challenge.
- Current methods struggle to prevent inadvertent reflux during subretinal delivery.
Purpose of the Study:
- To evaluate a modified partial fluid-air exchange (pFAX) technique.
- To assess the efficacy of pFAX in reducing reflux during subretinal injections.
- To improve the delivery and retention of subretinal therapeutics.
Main Methods:
- A single-center study involving 18 porcine eyes.
- Utilized human induced pluripotent stem cell (iPSC)-derived retinal sheets.
- Employed partial fluid-air exchange (pFAX) for subretinal injection.
Main Results:
- Successful delivery of retinal sheets in all eyes.
- pFAX minimized intraocular turbulence and reflux.
- Stable intraocular pressure, self-sealing wound, and bleb stability were maintained.
- Easier reaspiration and reinjection were possible with pFAX.
Conclusions:
- Partial fluid-air exchange effectively reduces reflux during subretinal injections.
- This technique enhances the stability and success of subretinal surgery.
- pFAX holds promise for improving current and future subretinal therapeutic applications.
