Purpose. To evaluate the effectiveness and safety of perfluorohexyloctane (F6H8) for intraoperative flattening of the retina and of F6H8/silicone oil (SO) 1000？cSt as a postoperative tamponade for inferior retinal detachment with inferior proliferative vitreoretinopathy. Methods. This is a retrospective review of 22 patients who underwent pars plana vitrectomy using F6H8 as an intraoperative tool to flatten the retina. At the end of the surgery a direct partial exchange between F6H8 and SO 1000？cSt was performed, tamponing the eye with different ratios of F6H8/SO (70/30, 60/40, 50/50, 40/30, and 30/70). Anatomical and functional results and complications were evaluated over the follow-up period (mean 22.63 months). Results. F6H8 was efficacious for intraoperative flattening of the retina. Twenty-one of the 22 patients achieved a complete retinal reattachment. Postoperative visual acuity (VA) ranged from light perception to 20/70, with 72% of patients obtaining VA better than 20/400. No emulsification/inflammation was observed whatever the ratio of F6H8/SO used. With higher ratios of F6H8/SO (70/30 and 60/40) cloudiness of the tamponade was observed. A transparent mixture was present with all the other ratios. Conclusions. The surgical technique adopted is very simple and safe. The optimal F6H8/SO ratio seems to be between 50/50 and 30/70. 1. Introduction The complexities associated with inferior retinal detachment (RD) complicated by inferior proliferative vitreoretinopathy (PVR) are well recognized [1]. In attempts to reduce the postoperative burden for patients, vitreoretinal surgeons have tested various substances with a specific gravity higher than water [1]. Fluorinated SO and perfluorocarbon liquids (PFCLs) have been used as alternative internal tamponades but are not well tolerated as long-term internal tamponades [1–4]. In the early 2000s partially fluorinated alkanes (FALKs) were introduced as long-term heavy tamponades [1]. Perfluorohexyloctane (F6H8) has a density of 1.3？g/cm3. Although its tolerability and biocompatibility have been demonstrated in the experimental animal and in human eyes, early F6H8 dispersion and emulsification with consequent inflammatory responses have frequently been reported [5–8]. The use of SO in combination with FALKs (heavy silicone oil, HSO), thereby increasing the viscosity of FALKs, has been suggested to reduce emulsification [9, 10]. Four different prefabricated mixtures of FALKs and SO of varying specific gravities and viscosities are now available: Oxane HD, Densiron 68, HWS 46–3000, and HWS 45–3000. All
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