Retinal Detachment With Giant Retinal Tear and Macular Hole

By Matteo Forlini, MD; Alesandro Romani, MD; and Purva Date, DNB, FVRS
 

A 61-year-old man presented with a sudden reduction in vision in his right eye (OD) lasting 3 days. His BCVA at presentation was 20/200 in each eye (OU). He had a history of cataract surgery OD performed 4 years earlier. Slit-lamp examination showed a normal anterior segment with pseudophakia OD and advanced cataract in the patient’s left eye (OS). Fundus examination revealed a complete retinal detachment OD with a giant retinal tear that extended from the 7 o’clock position to the 11 o’clock position, another small retinal tear at 3 o’clock, and a full thickness macular hole (Main Figure).

Vitrectomy was performed using 23-gauge instrumentation. The edges of the tear were unrolled, and complete retinal reattachment was achieved under perfluorocarbon liquid. Intraoperative endolaser was performed around the peripheral retina for 360° and around the edges of the tears. Perfluorocarbon liquid was exchanged with silicone oil 5000 cs as final tamponade (Inset, left).

At the 6-month follow-up visit, the patient’s retina was attached and the macular hole was repaired. It is possible to appreciate the wide scar in the temporal quadrant as a consequence of the giant retinal tear and the surrounding laser photocoagulation (Inset, right). A mild rise in intraocular pressure was successfully managed with a combination topical beta blocker and carbonic anhydrase inhibitor. Silicone oil tamponade remains in situ and is scheduled to be removed 9 months after the date of the primary vitrectomy. The patient’s BCVA is 20/125 OD.

Section Editor Manish Nagpal, MS, DO, FRCS (Edin)
• Senior Consultant, Retina and Vitreous Services, the Retina Foundation, Ahmedabad, India
drmanishnagpal@yahoo.com
• Financial disclosure: None

Matteo Forlini, MD
• Vitreoretinal Specialist, Domus Nova Hospital, Ravenna, Italy
matteoforlini@gmail.com
• Financial disclosure: None

Alessandro Romani, MD
• Ophthalmology Resident, Institute of Ophthalmology, University of Parma, Parma, Italy
alessandro.romani1@studenti.unipr.it
• Financial disclosure: None

Purva Date, DNB, FVRS
• Vitreoretinal Specialist, Aditya Jyot Eye Hospital, Wadala, Mumbai, India
drpurvadate@yahoo.in
• Financial disclosure: None

If you have an image or images you would like to share, email Dr. Nagpal.
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About Retina Today

Retina Today is a publication that delivers the latest research and clinical developments from areas such as medical retina, retinal surgery, vitreous, diabetes, retinal imaging, posterior segment oncology and ocular trauma. Each issue provides insight from well-respected specialists on cutting-edge therapies and surgical techniques that are currently in use and on the horizon.