Perfluoro-n-octane as tamponade agent in complex retinal detachments

INTRODUCTION The management of complex retinal detachments (RD) remains challenging mainly because of coexistent proliferative retinopathy (PVR). The attempts at prevention of PVR through pharmacological adjuvants have been modestly successful. Vitreoretinal surgeons therefore mostly manage PVR intraoperatively and explore alternative tamponade agents like heavy silicone oils (HSO) and perfluorocarbon liquids, individualizing treatment according to complexity of RD.AREAS COVERED After an introduction to PVR, the current surgical adjuncts and postoperative tamponade agents for complex RD are reviewed. The technique, advantages, limitations and complications of perfluoro-n-octane (PFO) as tamponade agent are compared with the alternatives. For best use of PFO as tamponade, case selection, postoperative posture and duration of tamponade need to be optimized. Judicious PFO usage improves the outcomes in complex and very complex RDs and early rehabilitation without any concerns of toxicity.EXPERT OPINION We recommend PFO as medium-term definitive tamponade for complex RD rather than as a short-term intermediate tamponade for staged surgeries. While adjuvant pharmacotherapy and HSO are popular alternatives, PFO aces them in availability, ease of use, quicker visual recovery and low cost. We foresee PFO replacing silicone oil in complex as well as simple RD when gas cannot be used.