•Keeping a highly mobile detached retina (relatively) immobile in RD surgery.

– Temporarily reattaching the macula to allow ILM peeling (see Sect. 32.1.6).

•Keeping an-already-opened funnel open in PVR surgery (see Sect. 32.3.1.5).

•Floating (lifting) dislocated lens particles or IOL or IOFBs toward the iris.

•Facilitating the removal of liquefied blood in eyes with suprachoroidal hemorrhage (see Sect. 60.2).

•Pushing residual subretinal fluid toward the retinotomy (see Sect. 31.1.2).

•Displacing submacular blood (see Sect. 36.4).

35.3.2 Surgical Technique

35.3.2.1 Implantation

•All tractions must be addressed before PFCL injection; otherwise, only small amounts to stabilize the retina may be used, and only if no posterior retinal break is present (see below).

•If possible, avoid injecting into an air-filled eye since the PFCL will rapidly start to evaporate and collect on the back surface of the IOL/posterior capsule (see Sects. 14.4 and 31.2). The evaporation is so fast that the PFCL disappears even from the bore of the needle13 and explains the introduction of a small air bubble every time PFCL is injected; multiple injections result in multiple air bubbles (see Fig. 33.1).

•Never inject the PFCL too fast. The BSS must drain to avoid a circulationstopping IOP elevation (see below).

•If the injection is not continuous, several large bubbles may form, but they will rapidly coalesce.

•If small amounts are injected and many small bubbles form,14 shake the eye and they will coalesce. To prevent the fish-egging, keep the flute needle’s tip inside the enlarging PFCL bubble.

•Never try to fill the vitreous cavity with PFCL if there is a posterior retinal break under traction.15 The bubble will escape into the subretinal space instead of flattening the retina. It is the traction, not the presence of the break, why PFCL is contraindicated.16

•If the PFCL is injected in order to be exchanged for silicone oil, it is best to fill the vitreous cavity completely. This avoids creating a “fluid sandwich,”17 in

13This is why it is only a waste of PFCL if the nurse tries the usual deaeration before she hands the PFCL-filled syringe over to the surgeon.

14Fish eggs.

15The same principle applies if BSS is reimplanted into an air-filled eye that had an RD and a posterior retinal break earlier during the operation.

16In other words, PFCL can be injected if the posterior break is not under traction. The only exception to this rule is a closed-funnel RD (see Sect. 32.3.1.6).

17BSS in-between silicone oil and PFCL.