Sandwich technique with anterior silicone oil and posterior perfluorocarbon liquid for intraoperative retinal stabilization in eyes with large retinal breaks

During retinal surgeries, the presence of large retinal defects or breaks (giant retinal tears or retinotomies ≥3 clock hours) requires the use of perfluorocarbon liquid (PFCL) to stabilize the posterior retina. Thereafter, direct PFCL-oil exchange is preferred to avoid posterior slippage of the retina. However, in an eye filled with PFCL, fluid currents at the surface of the PFCL pose a few problems when laser is attempted. Multiple bubbles are formed due to fluid currents, and the fluid jet from the infusion port may continually dislodge the free end of the retina despite the presence of PFCL. This effect is accentuated when instruments are exchanged or if the active port is unoccluded. On the other hand, if laser is postponed until the eye is filled with oil, fluid accumulation may occur under the macula, as posterior tamponade is absent. We present a modified technique that entails the use of a “sandwich” of anterior SO and posterior PFCL to comfortably perform laser in a well-formed closed vitreous chamber with continuous maintenance of retinal attachment.