Giant Retinal Tears
Surgical Techniques and Results Using Perfluorocarbon Liquids
Stanley Chang, MD; Harvey Lincoff, MD; Neal J. Zimmerman, MD; Wayne Fuchs, MD
\s=b\ Three low-viscosity perfluorocarbon
liquids provided an intraoperative tool
during vitrectomy to manage giant retinal
tears. These clear fluids have a high spe-
cific gravity (1.8 to 1.9) and are immisci-
ble with water. In six eyes, the giant tear
was less than 180\s=deg\;in 11 eyes, it was 180\s=deg\
or greater. In all eyes, the tear was
unfolded and the retina was flattened
while the patient was supine. The per-
fluorocarbon liquid was aspirated and
replaced by air-perfluorocarbon gas mix-
tures (16 eyes) or silicone oil (one eye) at
the end of the operation. The retina was
reattached in 16 eyes (94%), with a mini-
mum follow-up period of 6 months. In five
eyes (29%), the retina was reattached
without scleral buckling. Residual drop-
lets of perfluorocarbon liquid were
observed in four patients. These new
materials complement present surgical
techniques for managing giant retinal
tears.
(Arch Ophthalmol. 1989;107:761-766)
r"phe management of retinal
-*- ment associated with
detach-
giant retinal
tears has stimulated the development
of many innovative approaches to
unfold the flap of the tear and main¬
tain its position against the retinal
pigment epithelium. Intraocular gases
may require turning the patient
intraoperatively to unroll the flap of
the tear.1"7 Surgical tables have been
specially designed for this purpose.811
Silicone oil techniques require direct
bimanual manipulation of the retina
under the silicone oil interface until
Accepted for publication December 21, 1988.
From the Department of Ophthalmology, The
New York Hospital\p=m-\Cornell University Medical
Center, New York, NY.
Presented in part at the 16th Meeting of the
Club Jules Gonin, Brugges, Belgium, September
5, 1988.
Reprint requests to Department of Ophthal-
mology, The New York Hospital, 525 E 68th St,
New York, NY 10021 (Dr Chang).
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the flap is correctly positioned.1216 A
posterior retinotomy is occasionally
necessary to evacuate residual subre¬
tinal fluid after the giant tear is
closed. Methods have also been devel¬
oped to fixate the flap of the tear
intraoperatively, such as retinal
incarceration1718 or microincarcera-
tion"·20 retinal suturing,2124 retinal
tacks,2529 or retinal adhesives.30 These
procedures add additional risks to the
surgical procedure.
Various liquids with a higher spe¬
cific gravity than water have also
been used to unfold the flap of a giant
retinal tear and to flatten the retina
against the choroidal surface. The use
of hyaluronate sodium,31 fluorosili-
cone oil,32-33 and low-viscosity perfluor¬
ocarbon liquids34 has been previously
reported, but only in a few patients.
Of the available liquid substances, the
perfluorocarbons appear to offer the
greatest advantages in the intraoper¬
ative retinal manipulation of giant
tears. They have a higher specific
gravity that ranges from 1.6 to 2.0,
which can more easily flatten the ret¬
ina. They are immiscible with water,
and the interfacial tension that is
formed between perfluorocarbon liq¬
uid placed in saline solution is similar
to that of silicone oil in saline. The
low-viscosity liquids allow injection
into and removal from the eye easily
during surgery. This report summa¬
rizes the techniques, results, and com¬
plications of 17 consecutive patients
with giant retinal tears managed with
perfluorocarbon liquids intraopera¬
tively.
PATIENTS AND METHODS
We managed 17 consecutive patients
who had retinal detachments and giant
retinal tears with inverted flaps between
May 1, 1986, and March 1, 1988, with the
use of perfluorocarbon liquids intraopera¬
tively. Informed patient consent was
obtained under an investigational protocol
that was approved by the institutional
review board at Cornell University Medical
College, New York, NY. All patients were
operated on by one of us (S.C.). Fourteen
patients were male, and 3 were female,
with ages ranging from 10 to 70 years
(mean age, 31.4 years). Seven eyes had high
myopia (—7 to —27 diopters). Nine eyes
were phakic, and one lens was subluxated
in association with Marfan syndrome. Five
eyes were surgically aphakic (two, congen¬
ital cataract surgery), and three eyes were
pseudophakic (one, anterior chamber; two,
posterior chamber implants). Two patients
had giant retinal tears that had resulted
from penetrating ocular trauma. One eye
had had a previous filtering operation. Two
patients had previous scierai buckling sur¬
gery for the giant retinal tear, and 3
patients had had a previous lensectomy,
vitrectomy, and scierai buckling. In 1
patient, the giant retinal tear developed
along the posterior edge of cryotherapy,
resulting in a 120° tear (Table, patient 2).
In six eyes, the giant retinal tear was
less than 180°, and in 11 eyes, the tear was
greater than 180° (Table). Two eyes had
two tears; each was 90° or greater and both
eyes were included in the greater than 180°
group. Clinical signs of proliferative
vitreoretinopathy were present in seven
eyes: retinal stiffening and surface pig¬
mentary deposits on the retina in three
eyes, macular pucker or a star fold complex
in three eyes, and severe (Retina Society
Classification, grade D3) in one eye. One
patient (Table, patient 10) had preopera¬
tive choroidal detachment, and both
patients with penetrating trauma had vit¬
reous and subretinal blood.
Three perfluorocarbon liquids were
used: perfluorotributylamine in 4 eyes,
perfluorodecalin in 2 eyes, and perfluoro-
n-octane in 11 eyes. The physical proper¬
ties of these three compounds differ slight¬
ly and have been published previously.35
The perfluorocarbon liquids were purified
for intraocular use with a minimum purity
of 98%. The major impurities were frag¬
mented fully saturated perfluorocarbons
or isomers that could not be separated
from the parent compound.
Operative techniques varied throughout
this series of patients and became stan¬
dard as experience with the use of the
perfluorocarbon liquids accumulated. If
the vitreous was clear, transscleral cryo-
 Clinical Summary of 17 Patients

Patient/Sex Preoperative
Age, y Size of Tear,' History VisualAcuity Surgical Treatment
1/M/39 HM Vx, cryotherapy

2/F/70 120 ECCE and IOL 10 mo earlier; Vx, Vx, endophotocoagulation

SB, and C3F8 2 mo earlier
3/F/11 Myopia (—9 D); Lx, Vx, and LP Vx, endophotocoagulation
SB-giant tear 2 wk earlier
4/M/55 180 Vx, cryotherapy
5/M/16 90 Myopia (-26 D); SB X 2, PVR CF2' Vx, endophotocoagulation
grade C1
6/M/25 Traumatic cataract; ECCE-AC IOL Vx, SB, and cryotherapy
1 wk earlier
7/M/29 20/20 Vx, cryotherapy
8/M/29 120, 105 Myopia (-10 D) and lens 4/200 Lx, Vx, endophotocoagulation
subluxation (Marfan syndrome);
amblyopia
9/M/25 180 Myopia (—16 D); congenital
_
6/200 Vx, cryotherapy
nystagmus
10/M/50 ECCE and IOL 2 y earlier; choroidal Vx, SB and
detachment endophotocoagulation
11/M/41 180 Myopia (—7 D); SB 1 mo earlier 2/200 Vx, endophotocoagulation

12/M/31 Penetrating trauma, Lx, Vx, and SB LP Vx, endophotocoagulation

5 wk earlier; PVR D3 grade
13/M/13 300 Congenital cataract surgery; Scheie LP Vx, SB, and
procedure 1 mo earlier_ endophotocoagulation
14/F/28 210 Congenital cataract surgery Vx, SB, and
endophotocoagulation
15/M/41 Penetrating trauma repair 10 d LP Vx, SB, and
earlier endophotocoagulation
16/M/10 270 Myopia (-11 D) Vx, endophotocoagulation
17/M/20 150 Myopia (-8 D); PVR grade C1 Vx, cryotherapy

*
HM indicates hand motions; Vx, vitrectomy; ECCE, extracapsular cataract extraction; IOL, intraocular lens implant; SB, scierai buckle; C3F8, perfluoropropane; D,
diopters; Lx, lensectomy; LP, light perception; PVR, proliferative vitreoretinopathy; CF2', counting fingers at 2 ft; AC, anterior chamber; PFD, perfluorodecalin; C2F6,
perfluoroethane; PFO, perfluoro-n-octane; PFTBA, perfluorotributylamine; and F-G, fluid-gas.

pexy was first applied to treat each end of
the giant tear up to the ora serrata and to
surround any other retinal breaks. Ultra¬
sonic fragmentation of the lens was used to
remove a clear lens if it was subluxated or
when severe proliferative vitreoretinopa¬
thy (star folds or fixed retinal folds that
involved at least three quadrants) was
present. A conventional three-port 20-
gauge vitrectomy system was used to cut
and aspirate the anterior and cortical vit¬
reous. The flap of the retinal tear was
gently mobilized and unfolded bimanually
by using the light pipe and vitreous cutter
or membrane pick. Epiretinal membranes
were removed from both surfaces of the
retina as completely as possible. A small
amount of perfluorocarbon liquid (0.8 to
1.0 mL) was injected over the optic disc by
using a 23-gauge blunt cannula. This
allowed the flap of the tear to be partially
immobilized so that any epiretinal mem¬
branes that caused curling at the edge of
the tear could be removed. Perfluorocar¬
bon liquid was then added up to the edge of
the tear. Scierai depression was applied at
the ends of the tear to trim vitreous
strands to their insertion at the vitreous
base (Fig 1). Visibility of the edge of the
tear often disappeared as the perfluorocar¬
bon liquid flattened the retina to the
periphery. Indirect ophthalmoscopy was
then used to monitor the level of any
additional injection of the liquid. With the
tear in position, argon endophotocoagula¬
tion was applied through the perfluorocar¬
bon liquid along the edge of the tear in
aphakic eyes, visualizing through the oper¬
ating microscope. If the edge of the tear
was too peripheral for endophotocoagula¬
tion, one or two rows of transscleral cryo¬
therapy was placed along the posterior
edge of the tear under visualization with
indirect ophthalmoscopy (Fig 2). A scierai
buckle was placed in all earlier cases, but
not done in later cases unless proliferative
vitreoretinopathy was present. Localiza¬
tion for the scierai buckle was done while
perfluorocarbon liquid maintained the ret¬
inal tear in position.
Air-fluid exchange was performed in
two stages by using the automated air
infusion system. With the use of the flute
needle, the infusion fluid above the per¬
fluorocarbon liquid was removed as com¬ Fig 1.—Giant tear is repositioned by perfluor¬
pletely as possible by using the air to ocarbon liquid. Remaining cortical vitreous
flatten the anterior retina and displace all fibers at each end of tear are trimmed closely
anterior subretinal fluid before removal of by using scierai depression.
the perfluorocarbon (Fig 3). Endophoto¬
coagulation to the anterior retina was add¬ ing fluid-air exchange. It was corrected by
ed if necessary. The perfluorocarbon liquid replacing some of the air with saline solu¬
was then completely removed by using the tion and by using an expanding gas concen¬
flute needle. Posterior slippage of the tear tration after turning the patient into the
occasionally occurred to the equator dur- appropriate position postoperatively. The

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 With Giant Retinal Tears*

Perfluorocarbon Long-term Final

Liquid tamponade Subsequent Surgery Retinal Status Follow-up, mo Last Visual Acuity
Circumferential SB opposite tear 18 20/25
1 mo postoperatively; ECCE and
10 mo postoperatively
PFO C2F6 F-G exchange 1 mo later,
cryotherapy_
Silicone oil Revision Vx for PVR, grade D1 12

PFO C2F6 Attached 12 20/80

PFTBA C2F6 F-G exchange 1 mo later; argon
laser
C2F6 Photocoagulation

PFO C2F6 Attached 20/20

PFO C2F6 Photocoagulation Attached 10

PFO C2F6 F-G exchange and cryotherapy Attached

PFO C3F8 Photocoagulation, tear enlarged Attached retinal fold 15 20/60

PFTBA C2F6 Developed PVR grade D1-3 Attached 20/60

operations, including Lx, revision
of Vx and SB
PFO C3F8 Penetrating keratoplasty; revision of Attached 6/200
Vx for macular pucker
PFTBA C3F8 Revision Vx for PVR grade D1 2 mo Attached 20/400
later
C2F6

PFO C2F6 F-G exchange; laser 6 wk later Attached 20/30

PFO C2F6 Attached 20/200

PFO C2F6 Progressed to PVR grade D1; Attached 20/60
2 operations, including Lx, revision
of Vx, and SB

Fig 2. In phakic eyes, cryotherapy is applied after tear is flattened (left). Treatment is monitored by using indirect
ophthalmoscopy. In aphakic eyes or in eyes with previous scierai buckling, argon endophotocoagulation can be applied
—

through perfluorocarbon liquid by monitoring treatment through operating microscope (right). When retina is flattened,
dispersion of retinal pigment epithelial cells during thermal treatment is minimized.

vitreous cavity was flushed with a mixture
of air and perfluorocarbon gas at the end
of the operation (20% to 50% perfluoro-
ethane in 13 eyes; 17% to 20% perfluoro¬
propane in three eyes). Silicone oil (1000
centistokes) was used in one eye for long-
term tamponade because of the size of the
tear in a patient (Table, patient 3) who had
previously unsuccessful surgery.
Patients were examined postoperatively
weekly for the first month, and visual
acuity, slit-lamp examination, intraocular
pressure, gas bubble size, and funduscopic
findings wererecorded. After the disap¬
pearance of the gas bubble, patients were
followed up at 2-week intervals for 2
months and at longer intervals thereafter.
Photocoagulation was prophylactically

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 Fig 3.—Patient is supine during fluid-gas exchange. Vitreous fluid anterior to perfluorocarbon liquid is removed
completely by placing tip of flute needle near edge of tear (left). Chances for posterior slippage are reduced when
subretinal fluid is completely aspirated before removing perfluorocarbon liquid (right).

Fig 4.—Left, Fundus photograph of patient 14 taken 6 months postoperatively reveals small droplet of subretinal
perfluorodecalin near macula (arrow). Right, Fluorescein angiogram indicated minimal disturbance of retinal pigment
epithelium in vicinity of the droplet.

added to gaps between zones of thermally
induced chorioretinal adhesion. Reopera-
tions were done for recurrent retinal
detachments that ranged from fluid-gas
exchange and photocoagulation or cryo¬
therapy to vitrectomy and/or scierai buck¬
le revision. All patients had a minimum
follow-up period of 6 months after the last
retinal procedure. In two patients, follow-
up information was obtained from the
referring retinal surgeon.
RESULTS
Intraoperatively, the perfluorocar¬
bon liquids flattened the retina in all
17 eyes. Posterior retinotomy was not
required in any of the eyes. In one
patient (Table, patient 15), pooled sub¬
retinal blood was displaced peripher¬
ally out of the macular area, and the
blood could be aspirated through the
large tear as the level of perfluoro¬
carbon was increased. The perflu¬
orocarbon liquid was helpful in the
patient with severe proliferative
vitreoretinopathy (Table, patient 12)
by exposing residual membranes with¬
in the retinal folds and by providing
temporary stabilization of the retina
during membrane dissection. All of
the patients were supine throughout
the operation, and none required prone
positioning for air-fluid exchange.
Subsequent procedures for each
patient are noted in the Table. Four
patients required no further treat¬
ment, with the retina remaining
attached. Three patients underwent
prophylactic photocoagulation, with
one patient noted to have extension of
the tear 2 weeks following surgery. In
four patients, recurrent retinal de¬
tachment was treated with fluid-gas

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 exchange and cryotherapy or photoco¬
agulation. In three of these patients,
retinal detachment recurred from a
leak at the end of the giant retinal
tear. In one patient who was initially
treated without scierai buckling, a
localized retinal detachment devel¬
oped in an area opposite the supero¬
temporal giant retinal tear, and was
treated with segmentai scierai buck¬
ling. One patient underwent a vitrec¬
tomy revision for macular pucker.
Excluding the patient with severe pre¬
operative proliferative vitreoretino¬
pathy, 4 of the remaining 16 patients
progressed to grade D proliferative
vitreoretinopathy. A lensectomy with
a vitrectomy revision and/or a scierai
buckle was required in all four
patients. In two eyes, perfluorocarbon
liquids were used a second time to
stabilize the retina mechanically dur¬
ing membrane dissection. Following
additional surgery, the retinas of
three eyes were eventually reat¬
tached.
Overall, 16 (94% ) of the 17 eyes in
this series were reattached at the last
follow-up examination. Five patients
(29% ) were reattached without scierai
buckling. The visual results are sum¬
marized in the Table, with 15 of 17
eyes regaining 20/400 visual acuity or
better. In one patient, posterior slip¬
page of the giant retinal tear was
observed, but the fold did not traverse
the macula, and postoperative visual
acuity was 20/60.
Postoperative anterior segment
complications were found in two
patients. One patient developed a
nuclear cataract that required extra¬
capsular cataract extraction with pos¬
terior chamber lens implantation.
One patient with corneal scarring
from penetrating trauma underwent a
penetrating keratoplasty. One patient
with traumatic avulsion of the lens
and iris from penetrating ocular trau¬
ma developed glaucoma that was con¬
trolled medically.
Postoperatively, small droplets of
perfluorocarbon liquid were observed
in four patients. In two patients, small
droplets of perfluorocarbon liquid
were freely mobile on the surface of
the retina. In both patients, small
droplets were removed during reoper-
ation for retinal detachment. Howev¬
er, in one patient, small droplets of
perfluorotributylamine were observed
in the anterior chamber angle 20
months postoperatively. These three
clear droplets measured approximate¬
ly 250 µ in diameter and did not
elicit any inflammatory reaction. In
one patient, a small droplet of per-
fluoro-n-octane was adherent to the
inferior aspect of the scierai buckle
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and disappeared after 8 months. In
one patient, a small droplet of per-
fluorodecalin was observed postopera¬
tively subretinally in the paramacular
area (Fig 4). The patient had com¬
plained of a paracentral scotoma but
maintained postoperative visual acu¬
ity of 20/25. At 6 months, a visual
field examination revealed a scotoma
that corresponded to the area where
the liquid perfluorocarbon had set¬
tled. There was no underlying retinal
pigment epithelium abnormality or
retinal abnormality noted adjacent to
the droplet of perfluorocarbon liquid.
COMMENT
In all 17 eyes, the perfluorocarbon
liquids unfolded the inverted flap of
the giant retinal tear and flattened
the retina intraoperatively. As the
perfluorocarbon liquid was infused up
to the posterior edge of the tear, the
retina was repositioned closely to its
original location. Only a small gap of
bare retinal pigment epithelium was
exposed. Posterior retinotomy for
drainage of subretinal fluid was not
necessary because the high specific
gravity of the perfluorocarbon fluid
displaced all subretinal fluid anterior¬
ly. In giant tears that were compli¬
cated by proliferative vitreoretinopa¬
thy, the perfluorocarbon liquid pro¬
vided temporary mechanical stabili¬
zation during membrane dissection.
With expanding gas techniques,
cryotherapy is applied to an area of
bare retinal pigment epithelium
before the gas bubble is used to unfold
the tear and flatten it.4-6·7-24 The per¬
fluorocarbon liquid technique first
replaces the retinal tear against the
pigment epithelium, offering several
advantages. During cryotherapy, in¬
travitreal dispersion of the retinal
pigment epithelium36 is minimized,
and gravitational migration of loos¬
ened pigment epithelial cells under
the macula is avoided. Since the reti¬
nal tear is held in place, cryotherapy
application is more precise, and exces¬
sive treatment is minimized. Posteri¬
or slippage of the tear does not occur
during treatment. Localization for
scierai buckle placement is easier
when the posterior edge of the tear is
flattened. The interface of the per¬
fluorocarbon liquid can be visualized
throughout the operation, and the flu¬
id is removed passively with the flute
needle.
Current surgical techniques for
giant retinal tears that employ prone
fluid-gas exchange with gases or
internal tamponade techniques with
silicone oil have reported long-term
retinal reattachment rates that have
ranged from 43% to 90%.2·4714·15 The
temporary intraoperative use of per¬
fluorocarbon liquids assists in surgi¬
cal manipulation of the retina and
complements either technique. If air-
gas mixtures are planned for postop¬
erative retinal tamponade, the use of
perfluorocarbon liquids allow the
patient to be maintained in the supine
position, and prone fluid-gas ex¬
change can be avoided intraoperative-
ly. In this series, the patients were
turned at the end of the operation. In
some patients, slight posterior slip¬
page of the retinal tear occurred dur¬
ing air-fluid exchange and was
thought to result from the elasticity
of the internal limiting membrane
that caused the edge of the tear to curl
inward. The slippage was corrected
after the patient was turned. In one
patient, a retinal fold from posterior
slippage of the giant tear was noted
on the second postoperative day. The
fold did not involve the macula, and
the tear was treated with additional
photocoagulation. With the silicone
oil technique, the edge of the tear is
gently pulled under the meniscus of
the oil bubble which holds the tear in
position while fluid-oil exchange is
completed.1315 The edge of the tear
may be torn by this manuever. Occa¬
sionally, posterior retinotomy is
required to aspirate the subretinal
fluid completely.1516 The perfluorocar¬
bon liquid offers the ability to manip¬
ulate the tear hydraulically with min¬
imal trauma to the retinal edge from
microsurgical instrumentation. A
perfluorocarbon-silicone oil interface
is easily visualized as the silicone oil is
infused into the eye.
The experience from this series of
patients supports findings from previ¬
ous reports that giant retinal tears
without proliferative vitreoretinopa¬
thy can be managed without scierai
buckling.1·37 The ability to manipulate
and flatten the retina intraoperative-
ly with perfluorocarbon liquids of¬
fered confidence that the retina would
be in position postoperatively. Thus,
an encircling scierai buckle was not
thought to offer an added advantage
for retinal reattachment. Scierai
buckling was not done as part of the
initial procedure in seven eyes. Five
patients with tears 180° or larger
were reattached without scierai buck¬
ling. Two patients eventually required
scierai buckling. One patient devel¬
oped a localized detachment that was
treated with a segmentai scierai buck¬
le opposite to the giant tear. The other
patient developed severe proliferative
vitreoretinopathy (grade Dl) and was
reattached following lensectomy, vi¬
trectomy revision, and an encircling
scierai buckle. In some situations, the
 presence of a scierai buckle appeared
to be disadvantageous. Redundant
radial folds that result from scierai
buckling may be a factor that causes
failure.38 Postoperatively, fluid-gas
exchange was used to manage recur¬
rent retinal detachment. In phakic
eyes, photocoagulation of the retinal
periphery through the gas bubble was
difficult. The presence of a scierai
buckle limits the ability to apply suf¬
ficient cryotherapy to the break and
reduces the treatment options.
With the perfluorocarbon tech¬
nique, the clear lens was usually pre¬
served in phakic eyes. The subluxated
lens in the patient with Marfan syn¬
drome was removed at surgery, while
the remaining eight eyes were left
phakic. Ultimately, the lenses of two
patients were removed because of the
development of recurrent detachment
with proliferative vitreoretinopathy.
In one patient, a nuclear cataract pro¬
gressed and was extracted 10 months
postoperatively. Thus, at the end of
the follow-up period, five of eight
patients' eyes remained phakic. In
phakic eyes, the retinal periphery was
more difficult to visualize during flu¬
id-air exchange, but the long-term
reattachment rate was not affected.
There were no significant differ¬
ences between the three perfluorocar¬
bon liquids in their ability to flatten
the retina. Each of these compounds
was purified, and short-term retinal
toxicity studies in rabbit and pig eyes
have not revealed retinal toxicity
when the liquid is removed after 3
hours (S.C., T. Iwamoto, MD, unpub¬
lished data, 1986). The perfluorodecal-
in interface was less well seen com¬
pared with the other two compounds.
Perfluorotributylamine and perfluor-
odecalin are more viscous than per-
fluoro-n-octane, but each compound
could be removed easily with the flute
needle. We preferred perfluoro-n-
octane because of its low viscosity,
visible interface, and the availability
of a highly purified compound. Per-
fluoro-n-octane is also advantageous
because of its lower boiling point and
higher vapor pressure compared with
the other two compounds. With this
compound, small residual amounts
that remain on the retinal surface will
vaporize on exposure to air during
air-fluid exchange. While perfluoro-
n-octane appears to be a satisfactory
compound for use as an intraoperative
hydraulic tool, our laboratory is con¬
tinuing investigation of other com¬
pounds that may offer additional
advantages.
At the end of the follow-up period,
two patients had small droplets of
residual perfluorocarbon liquid. The
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potential long-term adverse effects of
these materials are unknown. The
droplets have not resulted in any clin¬
ically observable inflammatory ef¬
fects in the anterior chamber angle or
in the retinal pigment epithelium.
Considerable experience with per¬
fluorocarbon liquids used for artificial
blood replacement suggests that per-
fluorotributylamine and perfluorode-
calin are biologically inert. These
patients will require long-term obser¬
vation to assess any late adverse reac¬
tions. With the use of perfluoro-n-
octane and the accumulation of great¬
er surgical experience, the likelihood
of residual perfluorocarbon droplets
has been considerably reduced.
This study was supported in part by research
grant EY-05982-01 from the National Eye Insti¬
tute, Bethesda, Md, and the Vitreous Research
Fund, Cornell University Medical College, New
York, NY.
Dr Chang and the Cornell University Medical
College have applied for patent rights concerning
the intraoperative application of perfluorocar¬
bon liquids in complicated retinal detachments.
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