Fig. 4

Subfoveal perfluorocarbon (PFCL) liquid is adherent to the fovea during macular bleb creation. a Intraoperative image prior to creation of the macular bleb. The black and white arrowheads indicate the subfoveal and parafoveal PFCL droplets, respectively. b Intraoperative image after the creation of the macular bleb. The area of macular detachment includes both PFCL droplets. The retina was easily lifted off the parafoveal PFCL (white arrowhead) with the bleb creation, and the outline of the parafoveal PFCL droplet is now more obscured compared to Fig. a. However, the retina does not lift off the subfoveal PFCL (black arrowhead). The outline of the subfoveal droplet remains well delineated. c Schematic of subfoveal PFCL (black arrowhead), showing possible contact with the internal limiting membrane (ILM) via compressed or separate Müller cell cones. d On the other hand, the parafoveal PFCL (white arrowhead) appears to stay well beneath the outer retina and may make contact with the inner retinal layer, but not the ILM. e The arrows indicate the flow of the injected BSS. At the fovea, BSS does not significantly flow between the PFCL (black arrowhead) and the retina due to adhesion between the two. f However, at the parafoveal area, BSS flows easily between the PFCL (white arrowhead) and the retina, as shown by the arrow (f). g When the patient is repositioned vertically, the subretinally injected BSS gathers inferiorly, while the height of the retinal detachment inferior to the PFCL increases (double headed arrow). h Vibrational forces (gray arrow) break the adhesion between the PFCL and the retina (arrowhead). This causes the PFCL droplet to migrate inferiorly (arrow). i Adhesion between the surface of the subfoveal PFCL and Müller cell cones/ILM. To break this adhesion, a force greater than the intraocular pressure (arrows) multiplied by the area of the adhesion (red line) is required