Washout of Subretinal Fluid: A Novel Surgical Technique for Active Removal of Dense or Inflammatory Subretinal Fluid

Washout of Subretinal Fluid: A Novel Surgical Technique for Active Removal of Dense or Inflammatory Subretinal Fluid | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Washout of Subretinal Fluid: A Novel Surgical Technique for Active Removal of Dense or Inflammatory Subretinal Fluid Felipe Murati, Juan Yepez, J Fernando Arevalo, Igor Kozak This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8049437/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Objective: Persistent subretinal fluid (SRF) after retinal detachment repair can delay visual recovery and predispose proliferative vitreoretinopathy. Long-standing or exudative detachments often contain viscous or inflammatory SRF that resorbs poorly with standard drainage techniques. This study describes a controlled, vitrectomy-based “washout” technique for active evacuation of dense or inflammatory SRF using a modern aspiration–irrigation system. Patients and Methods: The technique was applied in patients with chronic rhegmatogenous or exudative retinal detachment containing persistent SRF. A 23-gauge anterior chamber maintainer provided continuous infusion, and a 23-gauge valved trocar allowed oblique transscleral access to the subretinal space. A soft silicone-tipped cannula connected to the Constellation® vitrectomy system was used for controlled aspiration under direct visualization. Results: The technique has been performed in three eyes (two with chronic macula-off RRD and one with Stage 3B Coats disease), all achieving complete retinal reattachment and was enabled to complete evacuation of viscous or loculated SRF while maintaining intraocular pressure and retinal integrity. No intraoperative hypotony, hemorrhage, or retinal trauma occurred. All cases achieved complete retinal reattachment. Conclusion: The washout technique offers a safe, controlled, and reproducible method for active removal of dense or inflammatory SRF. It improves intraoperative control, minimizes complications associated with passive drainage, and facilitates anatomic success in complex retinal detachment surgery. subretinal fluid retinal detachment vitrectomy surgical technique proliferative vitreoretinopathy Coats disease Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Persistent subretinal fluid (SRF) after retinal detachment repair is a recognized cause of delayed anatomical and functional recovery. 1 Long-standing retinal detachments frequently contain SRF with increased viscosity, cellular content, and high protein concentration, which resorbs slowly due to reduced retinal pigment epithelium (RPE) pump activity.¹ In exudative retinal detachments, such as advanced Coats disease, massive subretinal exudation can produce subtotal or total retinal detachment that often necessitates surgical evacuation of SRF for reattachment. 2 Traditional drainage approaches, such as needle puncture or posterior retinotomy may lead to uncontrolled outflow, subretinal hemorrhage, or retinal incarceration. 3 To address these limitations, we developed a vitrectomy-based “washout” technique that uses a controlled irrigation–aspiration system to actively remove dense or inflammatory SRF while maintaining intraocular pressure (IOP) and minimizing retinal stress. The purpose of this report is to describe the stepwise technique and its advantages over conventional methods. PATIENTS AND METHODS This technique was performed in patients with chronic rhegmatogenous or exudative retinal detachment presenting with persistent or organized SRF despite standard drainage methods. All procedures were conducted at the Private Center, Clinica de Ojos Maracaibo, Venezuela, with approval from the institutional ethics committee. Written informed consent was obtained from all patients for surgical procedures and use of anonymized images. The technique employs standard pars plana vitrectomy equipment integrated with the Constellation® Vitrectomy System (Alcon Laboratories, Fort Worth, TX, USA). Essential materials include a 23-gauge valved trocar, soft silicone-tipped subretinal cannula, and a 23-gauge anterior chamber maintainer for infusion. RESULTS The technique was applied in three eyes from three patients presenting chronic rhegmatogenous retinal detachment or exudative detachment secondary to Coats disease, each with persistent or loculated subretinal fluid. This procedure is performed under local anesthesia (retrobulbar or peribulbar block). A 23-gauge anterior chamber maintainer is first inserted through the peripheral cornea to provide continuous balanced salt solution infusion and stabilize IOP. A 23-gauge valved trocar is placed transscleral at an oblique angle approximately 6–7 mm posterior to the limbus, in an area of detached retina. The oblique approach minimizes the risk of choroidal injury and facilitates self-sealing of the sclerotomy. Through the trocar, a soft silicone-tipped subretinal cannula is gently introduced into the subretinal space under direct microscope visualization. The vitrectomy system is set to aspiration mode with a vacuum limit of ≤ 200 mmHg. Using foot-pedal control, active suction is gradually applied to evacuate SRF while the anterior chamber maintainer maintains counterpressure to prevent hypotony. The surgeon observes the retinal surface during aspiration: as SRF is removed, the retina flattens and may exhibit gentle undulating movement. Aspiration is paused if the retina nears the cannula tip to prevent retinal contact or incarceration. In cases of highly viscous or proteinaceous SRF, minor inflow from the infusion line facilitates mixing and gentle lavage, enhancing fluid mobilization. Aspiration continues until no subretinal pockets remain and the retina is fully reattached. The cannula is then withdrawn; the sclerotomy typically self-seals, though a single 8 − 0 vicryl suture may be placed if leakage is noted. The anterior chamber maintainer is removed, and standard endolaser photocoagulation and tamponade (gas or silicone oil) are performed as indicated. DISCUSSION The washout technique provides a safe and controlled approach for the active removal of dense or inflammatory SRF during complex retinal detachment repair. It combines continuous infusion with adjustable vacuum aspiration to ensure stable intraocular pressure and minimize the risks of acute hypotony, retinal trauma, or hemorrhage seen with needle-based drainage. 3 This method is particularly useful in chronic rhegmatogenous and exudative detachments where conventional passive drainage is insufficient. The soft silicone-tipped cannula allows atraumatic entry into the subretinal space, and the oblique transscleral approach promotes wound stability. Active lavage may also decrease postoperative PVR by reducing subretinal inflammatory or proteinaceous load. 1 Recent reports support the efficacy of active aspiration techniques. Zhu et al. demonstrated that automated SRF aspiration during scleral buckling achieved complete reattachment without major complications. 3 Similarly, in our experience, the washout method achieved complete retinal reattachment and stable postoperative outcomes in challenging chronic and exudative detachments. This simple adaptation of modern vitrectomy platforms broadens the surgical toolkit for vitreoretinal surgeons dealing with organized or inflammatory subretinal collections. Declarations Author Contribution F.M. contributed the surgical technique, collected clinical data, performed the surgeries, and wrote the first draft of the manuscript.J.B.Y. concieved to surgical planning, clinical interpretation, and manuscript editing.J.F.A. provided critical revision of the surgical technique description and contributed to the discussion and literature review.I.K. supervised the project, contributed to methodology development, revised the manuscript for important intellectual content, and approved the final version.All authors reviewed and approved the final manuscript. References Veckeneer M, Derycke L, Lindstedt EW, Van Meurs JC, Cornelissen M, Bracke M, et al. Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment: hypothesis and review. Graefes Arch Clin Exp Ophthalmol. 2012;250(6):795–802. Shields JA, Shields CL, Honavar SG, Demirci H, Cater J. Clinical variations and complications of Coats disease in 150 cases: The 2000 Sanford Gifford Memorial Lecture. Am J Ophthalmol. 2001;131(5):561–571. Zhu K, Gu Y, Li X, Zhou E, He Q, Gu Q. A Novel Automated Aspiration of Subretinal Fluid Method During Scleral Buckling for Rhegmatogenous Retinal Detachment. Retina. 2025;45(6):1218–1224. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8049437","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":552504583,"identity":"0f60487b-20a7-406c-8a0f-aad81300b69a","order_by":0,"name":"Felipe Murati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBAC9gYwJSHHwMDYABVLwK+F5wBYkYQxyVoYEhsQYoS0iJ0x+/Dzh0V6/+zDzR8+7rBj4GfPMcCvRTrHeGZPgkTujHOJDYYzzyQzSPa8wa/FHqiFgQeopeEMY0Mybxszg8ENImxh/JMgkS4P1HKYt62ewZ4YLcxAWxIMzjA2NvO2HWYwkCCoJa2YWSZNwnDjGcZmxpltx3kkzjwrIKAleTPjG5s6ebkz7I8/fGyrluNvT96AVwumGaQpHwWjYBSMglGAFQAASRI/LEd2kdcAAAAASUVORK5CYII=","orcid":"","institution":"University of Arizona","correspondingAuthor":true,"prefix":"","firstName":"Felipe","middleName":"","lastName":"Murati","suffix":""},{"id":552504584,"identity":"53aa31bc-31da-48ad-abe9-a006d2846f74","order_by":1,"name":"Juan Yepez","email":"","orcid":"","institution":"Clinica de Ojos","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"Yepez","suffix":""},{"id":552504585,"identity":"f43835d3-a86c-42a6-a9ad-4d1028cc9fb9","order_by":2,"name":"J Fernando 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14:06:38","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":20625,"visible":true,"origin":"","legend":"","description":"","filename":"31469db3e1194fa2834017b67ec00d411structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8049437/v1/16191f40891e93ab52658115.xml"},{"id":97261580,"identity":"30c80369-5e74-4373-b337-5f0115b4ec4c","added_by":"auto","created_at":"2025-12-02 14:06:39","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":26485,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8049437/v1/82fb7f573ea5087ac93693d7.html"},{"id":97367561,"identity":"5f6dd755-0e13-4ac9-8833-66266e1ce3f9","added_by":"auto","created_at":"2025-12-03 16:19:26","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1192253,"visible":true,"origin":"","legend":"\u003cp\u003eBegin by placing the anterior chamber maintainer, which helps regulate infusion and maintain stable intraocular pressure during the subretinal fluid washout procedure. Next, insert the oblique trocar approximately 6–7 mm posterior to the limbus to achieve transscleral subretinal access. In the illustration, the white arrow denotes the peripheral fluid pocket and highlights the elevation of the retina caused by the accumulated subretinal fluid.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8049437/v1/1a1223d4f0897f5e69e5e818.jpeg"},{"id":97261576,"identity":"d0a929c2-3178-4f53-b302-dee858316488","added_by":"auto","created_at":"2025-12-02 14:06:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1839254,"visible":true,"origin":"","legend":"\u003cp\u003eSubretinal cannula navigation under the detached retina, guided by direct visualization to target the fluid pocket. The white arrow indicates the area where initial aspiration was applied, which appears to correspond with a localized reduction of subretinal fluid and partial flattening of the retinal surface.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8049437/v1/65f4602327a9cd11b48c1c98.png"},{"id":97367518,"identity":"884f5036-df91-4693-a7f0-d540e65b5c2f","added_by":"auto","created_at":"2025-12-03 16:19:04","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":216410,"visible":true,"origin":"","legend":"\u003cp\u003eSequence left to right represent; controlled aspiration uses a foot pedal to remove subretinal fluid. The white arrow shows blood clot aspiration.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8049437/v1/9a7677a9b7df66b6249e7fa9.jpeg"},{"id":104400652,"identity":"954e9722-228b-40a3-8a95-bf9a7fe3cfd9","added_by":"auto","created_at":"2026-03-11 12:10:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4758622,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8049437/v1/bfdaa163-b252-4850-9cde-55f119e8cfa4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Washout of Subretinal Fluid: A Novel Surgical Technique for Active Removal of Dense or Inflammatory Subretinal Fluid","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePersistent subretinal fluid (SRF) after retinal detachment repair is a recognized cause of delayed anatomical and functional recovery.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Long-standing retinal detachments frequently contain SRF with increased viscosity, cellular content, and high protein concentration, which resorbs slowly due to reduced retinal pigment epithelium (RPE) pump activity.\u0026sup1; In exudative retinal detachments, such as advanced Coats disease, massive subretinal exudation can produce subtotal or total retinal detachment that often necessitates surgical evacuation of SRF for reattachment.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTraditional drainage approaches, such as needle puncture or posterior retinotomy may lead to uncontrolled outflow, subretinal hemorrhage, or retinal incarceration.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e To address these limitations, we developed a vitrectomy-based \u0026ldquo;washout\u0026rdquo; technique that uses a controlled irrigation\u0026ndash;aspiration system to actively remove dense or inflammatory SRF while maintaining intraocular pressure (IOP) and minimizing retinal stress. The purpose of this report is to describe the stepwise technique and its advantages over conventional methods.\u003c/p\u003e"},{"header":"PATIENTS AND METHODS","content":"\u003cp\u003eThis technique was performed in patients with chronic rhegmatogenous or exudative retinal detachment presenting with persistent or organized SRF despite standard drainage methods. All procedures were conducted at the Private Center, Clinica de Ojos Maracaibo, Venezuela, with approval from the institutional ethics committee. Written informed consent was obtained from all patients for surgical procedures and use of anonymized images.\u003c/p\u003e\u003cp\u003eThe technique employs standard pars plana vitrectomy equipment integrated with the Constellation\u0026reg; Vitrectomy System (Alcon Laboratories, Fort Worth, TX, USA). Essential materials include a 23-gauge valved trocar, soft silicone-tipped subretinal cannula, and a 23-gauge anterior chamber maintainer for infusion.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe technique was applied in three eyes from three patients presenting chronic rhegmatogenous retinal detachment or exudative detachment secondary to Coats disease, each with persistent or loculated subretinal fluid. This procedure is performed under local anesthesia (retrobulbar or peribulbar block). A 23-gauge anterior chamber maintainer is first inserted through the peripheral cornea to provide continuous balanced salt solution infusion and stabilize IOP.\u003c/p\u003e\u003cp\u003eA 23-gauge valved trocar is placed transscleral at an oblique angle approximately 6\u0026ndash;7 mm posterior to the limbus, in an area of detached retina. The oblique approach minimizes the risk of choroidal injury and facilitates self-sealing of the sclerotomy.\u003c/p\u003e\u003cp\u003eThrough the trocar, a soft silicone-tipped subretinal cannula is gently introduced into the subretinal space under direct microscope visualization. The vitrectomy system is set to aspiration mode with a vacuum limit of \u0026le;\u0026thinsp;200 mmHg. Using foot-pedal control, active suction is gradually applied to evacuate SRF while the anterior chamber maintainer maintains counterpressure to prevent hypotony.\u003c/p\u003e\u003cp\u003eThe surgeon observes the retinal surface during aspiration: as SRF is removed, the retina flattens and may exhibit gentle undulating movement. Aspiration is paused if the retina nears the cannula tip to prevent retinal contact or incarceration. In cases of highly viscous or proteinaceous SRF, minor inflow from the infusion line facilitates mixing and gentle lavage, enhancing fluid mobilization.\u003c/p\u003e\u003cp\u003eAspiration continues until no subretinal pockets remain and the retina is fully reattached. The cannula is then withdrawn; the sclerotomy typically self-seals, though a single 8\u0026thinsp;\u0026minus;\u0026thinsp;0 vicryl suture may be placed if leakage is noted. The anterior chamber maintainer is removed, and standard endolaser photocoagulation and tamponade (gas or silicone oil) are performed as indicated.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe washout technique provides a safe and controlled approach for the active removal of dense or inflammatory SRF during complex retinal detachment repair. It combines continuous infusion with adjustable vacuum aspiration to ensure stable intraocular pressure and minimize the risks of acute hypotony, retinal trauma, or hemorrhage seen with needle-based drainage.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis method is particularly useful in chronic rhegmatogenous and exudative detachments where conventional passive drainage is insufficient. The soft silicone-tipped cannula allows atraumatic entry into the subretinal space, and the oblique transscleral approach promotes wound stability. Active lavage may also decrease postoperative PVR by reducing subretinal inflammatory or proteinaceous load.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eRecent reports support the efficacy of active aspiration techniques. Zhu et al. demonstrated that automated SRF aspiration during scleral buckling achieved complete reattachment without major complications.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Similarly, in our experience, the washout method achieved complete retinal reattachment and stable postoperative outcomes in challenging chronic and exudative detachments. This simple adaptation of modern vitrectomy platforms broadens the surgical toolkit for vitreoretinal surgeons dealing with organized or inflammatory subretinal collections.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eF.M. contributed the surgical technique, collected clinical data, performed the surgeries, and wrote the first draft of the manuscript.J.B.Y. concieved to surgical planning, clinical interpretation, and manuscript editing.J.F.A. provided critical revision of the surgical technique description and contributed to the discussion and literature review.I.K. supervised the project, contributed to methodology development, revised the manuscript for important intellectual content, and approved the final version.All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVeckeneer M, Derycke L, Lindstedt EW, Van Meurs JC, Cornelissen M, Bracke M, et al. Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment: hypothesis and review. Graefes Arch Clin Exp Ophthalmol. 2012;250(6):795\u0026ndash;802.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShields JA, Shields CL, Honavar SG, Demirci H, Cater J. Clinical variations and complications of Coats disease in 150 cases: The 2000 Sanford Gifford Memorial Lecture. Am J Ophthalmol. 2001;131(5):561\u0026ndash;571.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu K, Gu Y, Li X, Zhou E, He Q, Gu Q. A Novel Automated Aspiration of Subretinal Fluid Method During Scleral Buckling for Rhegmatogenous Retinal Detachment. Retina. 2025;45(6):1218\u0026ndash;1224.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"subretinal fluid, retinal detachment, vitrectomy, surgical technique, proliferative vitreoretinopathy, Coats disease","lastPublishedDoi":"10.21203/rs.3.rs-8049437/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8049437/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Objective:\u003c/strong\u003e Persistent subretinal fluid (SRF) after retinal detachment repair can delay visual recovery and predispose proliferative vitreoretinopathy. Long-standing or exudative detachments often contain viscous or inflammatory SRF that resorbs poorly with standard drainage techniques. This study describes a controlled, vitrectomy-based “washout” technique for active evacuation of dense or inflammatory SRF using a modern aspiration–irrigation system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients and Methods:\u003c/strong\u003e The technique was applied in patients with chronic rhegmatogenous or exudative retinal detachment containing persistent SRF. A 23-gauge anterior chamber maintainer provided continuous infusion, and a 23-gauge valved trocar allowed oblique transscleral access to the subretinal space. A soft silicone-tipped cannula connected to the Constellation® vitrectomy system was used for controlled aspiration under direct visualization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe technique has been performed in three eyes (two with chronic macula-off RRD and one with Stage 3B Coats disease), all achieving complete retinal reattachment and was enabled to complete evacuation of viscous or loculated SRF while maintaining intraocular pressure and retinal integrity. No intraoperative hypotony, hemorrhage, or retinal trauma occurred. All cases achieved complete retinal reattachment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The washout technique offers a safe, controlled, and reproducible method for active removal of dense or inflammatory SRF. It improves intraoperative control, minimizes complications associated with passive drainage, and facilitates anatomic success in complex retinal detachment surgery.\u003c/p\u003e","manuscriptTitle":"Washout of Subretinal Fluid: A Novel Surgical Technique for Active Removal of Dense or Inflammatory Subretinal Fluid","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 14:06:34","doi":"10.21203/rs.3.rs-8049437/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6d78b80d-6ab4-4d4c-add2-f861390e0c06","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T21:23:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 14:06:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8049437","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8049437","identity":"rs-8049437","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}