Subretinal injection under perfluorocarbon liquids to avoid foveal dehiscence.

PURPOSE To describe a novel method of subretinal injection to reduce the risk of foveal dehiscence during subretinal tissue plasminogen activator (TPA) delivery for submacular haemorrhage. METHOD Description of technique with illustrative case description and details of four cases treated. The subretinal injection is delivered under a perfluorocarbon liquid (PFCL) bubble filling 80% of the vitreous cavity. An eccentric injection point is used and the TPA injected under pneumatically controlled viscous fluid injection system with a 38g polyimide cannula and low injection pressure. RESULTS Four cases have been treated with controlled subretinal injection extending under the fovea without dehiscence, including one case with apparent pre-existing foveal dehiscence and a pre retinal clot. CONCLUSION The technique allows the creation of a low more diffuse subretinal bleb compared to without PFCL, minimising hydraulic stress on the fovea during injection and could be applied to other subretinal injection scenarios where the fovea is at risk of hydraulic blow out. Further experience of the technique is needed to validate this initial report.