PaCE: a technique to avoid subretinal fluid drainage in retinal detachment surgery

Purpose: Subretinal fluid (SRF) drainage and thus the potential complications of this procedure during scleral buckling can be avoided by inducing SRF absorption preoperatively. The technique described in this series is named PaCE (Pneumatic Cryo Explant). Methods: A total of 22 eyes of 22 patients with primary bullous rhegmatogenous retinal detachment (RRD) were included in this prospective non-comparative case trial. All satisfied specific inclusion criteria similar to those used in previous pneumatic retinopexy (PR) studies. Under direct visualization, 0.3 ml C3F8 100% was injected into the vitreous cavity through the pars plana. Postoperative posturing was encouraged. Retinopexy with either cryotherapy or laser was performed, combined with scleral buckling (SB) when the SRF was absorbed. Avoidance of SRF drainage and persistent reattachment of the retina at the end of the 12-month follow-up was considered a successful outcome. A change in vision by one line (logMAR) was considered significant. Results: Resolution of SRF before retinopexy and the SB procedure was achieved in 20 of 22 eyes (90.9%) and hence SRF drainage was not required. Visual improvement was achieved in 95% of cases. One eye (4.5%) lost vision due to a total RD after gas injection (further surgery was not carried out). Conclusion: PaCE should be considered in any suitable case of primary RRD where SRF drainage is deemed necessary. The potential complications associated with this procedure are relatively less serious and it does not compromise the viability of subsequent procedures.