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Vitrectomy and peeling techniques for complicated retinal detachment such as severe proliferative vitreoretinopathy and advanced diabetic tractional retinal detachment are found to be ineffective in achieving retinal reattachment. In such cases, a surgical procedure called 'Retinectomy' is performed.

Retinectomy refers to the excision (removal) of the retina. During retinectomy, the complete peripheral retina may be excised, but the central retina is untouched as its function is more important for vision. Excising only the peripheral retina also prevents post-operative proliferation and traction.

The following are the surgical steps to perform a retinectomy:

  • Thorough hemostasis (a process to stop bleeding)
  • Incision of the retinal tissue cautiously to avoid any damage to the choroid (thin layer of blood vessels between the retina and white outer part of the eye)
  • Removal of tissue debris
  • Excision (removal) of the peripheral retina
  • Complete reattachment of the retina using air or liquids to temporarily hold the retina in place
  • Endolaser retinopexy, the surgical correction along the margins of the retinectomy by forming adhesions between the retina and the adjacent choroid layer
  • Placement of a long-acting intraocular tamponade such as silicone oil or various gases to hold the retina in place. Generally silicone oil is preferred.
  • It has been reported that cases of retinectomy with the use of silicone oil in severe PVR were successful with minimal risk of recurrence.

Perfluorocarbon(PFCL)

In cases of larger circumferential tears, liquid perfluorocarbon (PFCL), a material with high specific gravity and low viscosity is used during retinectomy surgery to stabilize the retina. PFCL, essential for the management of large retinal tears, is injected over the optic disc (circular area at the back of the eye where the optic nerve connects to the retina). The aim of PFCL injections is to assess the residual tractional elements (elements pulling the retina) and stabilize the retina for retinectomy and excision of the peripheral retina as well as drainage of subretinal fluid. By effectively stabilizing the retina, PFCLs facilitate the repair of complicated retinal detachments due to proliferative vitreoretinopathy (PVR). At the end of retinectomy, PFCL is exchanged for either gas or silicone oil.

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