Subretinal perfluorocarbon retention is a potential adverse consequence after PFC use in retinal detachment repair. Though, posterior migration of peripheral subretinal PFC toward the fovea is a recognized phenomenon, spontaneous peripheral migration away from the fovea and the anatomical findings during migration have not been described. Multiple studies have shown that even with highly purified PFCLs, retinal toxicity occurs after just a few days of intravitreal PFCL exposure and an even shorter period for subretinal PFCL.4–6
In this report, we demonstrate a case of spontaneous resolution of subfoveal PFCL. Examination of the posterior and peripheral retina just revealed FTMH without any subretinal PFCL droplets following release. We hypothesize that the surface tension of the PFCL droplet resulted in tangential forces that created a defect at the fovea. We suggest that the PFCL droplet extruded through this retinal defect into the vitreous cavity, where it remained undetected, but was subsequently removed during silicone oil removal. The possibility of retinal hole formation due to chronic subretinal PFCL retention with a very thin overlying retina has been reported in the literature.
Ghoraba et al,7 revealed spontaneous formation of macular holes in 2 patients. In those 2 patients, subfoveal PFCL droplets disappeared. Also, Tanabu et al,8 reported a case of macular hole secondary to subfoveal perfluorocarbon that subsequently closed after its spontaneous resolution. This occurred after doing a vitrectomy for traumatic retinal detachment. They speculated that the retinal structure in the macula was fragile. Thus, subretinal PFCL droplets were likely to release more easily. Also, they explained that in eyes in which the internal limiting membrane has already become detached or removed PFCL droplets are more likely to be spontaneously discharged.
Toth et al, reported a large PFCL bubbles spontaneously migrated from the fovea in a downward direction or a subretinal PFCL droplet subsequently disappeared from the central fovea, resulting in improvement of the retinal structure 9. Also, Oellers et al.10 postulated that the PFCL droplet discharged through a transient hole created in the thinned retina overlying the droplet spontaneously, which later closed leaving the macula flat & atrophic.
OCT was important tool especially for follow up those patients & for the differential diagnosis of retained subretinal fluid, subretinal SO, sticky silicone oil and subretinal PFCL due to their differences in viscosity, density and surface tension. Entrapped PFCL bubble has distinct border & retina take the shape of omega sign (Ώ) thus the angle between RPE & neurosensory retina at base of PFCL bubble is acute and retinal layers can't be identified above PFCL droplet as whole retina were being squeezed with hyper-reflective shadow at the choroid.7
As regard VA, it was dramatically improved in our patient after release PFCL droplet & closure of MH and reached 0.7. This agree with Oellers et al.,10 who reported in their case VA improvement to 20/70 at 6 weeks following oil removal, with sustained retinal attachment, absence of any retained PFCL, and continued improvement of the retinal contour and microarchitecture.
The mechanism of this unusual event is rarely reported in literature and poorly recognized as different behaviors and scenarios of submacular PFCL droplets may occur. In the future, improved understanding of the mechanisms of spontaneous resolution may enable the development of nonsurgical or minimal invasive techniques to remove subfoveal PFCL.