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

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.