Perfluorotributylamine is a high-carbon liquid fluoride characterized by high oxygen-carrying capacity, colorlessness, transparency, and a specific gravity higher than that of water. Initially developed as a blood substitute for extracorporeal circulation in cardiothoracic surgery, it has recently been utilized in ophthalmology due to its unique physical properties. Serving as a temporary intraocular tamponade, it significantly improves surgical techniques by flattening and fixing the retina.

 

Perfluorotributylamine is colorless, transparent, and low in viscosity, making it easy to inject and remove. Its refractive index is close to that of water, but its specific gravity is greater, and it possesses strong surface tension, being immiscible with water. When injected into the eye, it forms a meniscus interface on the retinal surface, thereby exerting a flattening and fixing effect on the retina. As a temporary intraocular tamponade, no chemical toxicity has been observed to date.

 

For patients with giant retinal tears, particularly those with flipped posterior retinal flaps, reattachment via fluid-gas exchange was historically difficult. This challenge was exacerbated in the absence of a rotating operating table. The application of perfluorotributylamine simplifies the procedure significantly. Following vitrectomy and peeling of abnormally proliferative membranes, once retinal mobility is essentially restored, slow injection of perfluorotributylamine in front of the optic disc gradually flattens the retina while expelling Subretinal Fluid (SRF) through peripheral breaks.

 

In cases with residual epiretinal membranes, the interface makes them easier to identify and peel. This allows for alternating between injection and peeling until the retina is completely flattened. Endophotocoagulation or external cryopexy is then applied at the edge of the breaks. Retinas flattened by this high-carbon liquid fluoride demonstrate good stability, preventing slippage at the tear edges and minimizing residual subretinal fluid.

 

The underlying principles are as follows:

 

 

Critical Note: It is important to prevent the posterior migration of subretinal fluid, as this can interfere with intraoperative laser application. This situation typically arises when subretinal fluid anterior to the heavy liquid interface is not completely drained. Therefore, prior to removing the heavy liquid, a localized fluid-gas exchange should be performed in the upper portion of the interface. The globe should then be tilted away from the break to expel peripheral subretinal fluid and flatten the peripheral retina. Only then should the heavy liquid be removed and replaced with an air-fluid exchange.