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‘Bubbles in my eye’. Perfluorocarbon liquid residue in the anterior chamber

A 62-year-old man reported to the eye clinic complaining of ‘bubbles in his eye’. He reported seeing circular floaters in the field of vision of one eye for the previous three months and only noticed them when lying on his back or reading. They were described as translucent with no associated photopsiae or metamorphospsiae (Figure 1). The same eye had a significant previous history, including diagnosis of a macular hole three years earlier, for which he underwent a successful pars plana vitrectomy/internal limiting membrane peel/gas insertion with postoperative visual acuity of 6/9. He subsequently developed a mixed posterior subscapular and nuclear cataract and had complicated cataract surgery with a dropped nucleus. The following week this was retrieved and perfluorocarbon (heavy liquid) was used to float the nucleus using posterior assisted levitation. After successful removal of the dropped nucleus, an anterior chamber intraocular lens was inserted and good vision restored (6/12). At presentation, his intraocular pressure was 37 mmHg in the affected eye with some early optic disc cupping, and his visual acuity remained at 6/12. His symptoms of ‘bubbles’ were presumed to be due to vitreous cavity debris causing floaters; however, there were no opacities to adequately explain the floaters and no description of intraocular lens-related dysphotopsias. No apparent cause for the raised intraocular pressure was found with the slitlamp and gonioscopy. His foveal architecture was normal (confirmed on optical coherence tomography) and there was no evidence of peripheral retinal damage or gross debris to explain his signs and symptoms; however, a number of droplets of retained perfluorocarbon were ultimately seen and were consistent with the patient’s symptoms (Figure 2). The patient underwent successful anterior segment washout and at postoperative visits at one week and one month, his intraocular pressure remained under 20 mmHg without ocular antihypertensives and his symptoms of ‘bubbles’ had resolved. DISCUSSION