Posterior pole retinal breaks causing posterior pole retinal detachment in a middle-aged man with retinal vasculitis and moderate myopia

2021 ◽  
Vol 14 (2) ◽  
pp. e239012
Author(s):  
Deepika Chennapura Parameswarappa ◽  
Nidhi Mahendra Vithalani ◽  
Padmaja Kumari Rani
Keyword(s):  
Retinal Detachment ◽  
Retinal Vasculitis ◽  
Vitreoretinal Surgery ◽  
Intravitreal Bevacizumab ◽  
Posterior Pole ◽  
Vitreous Haemorrhage ◽  
Mantoux Test ◽  
Retinal Breaks ◽  
The Right

A 38-year-old man presented with sudden decreased vision in the right eye 3 years ago due to vitreous haemorrhage. During follow-up, right eye fundus showed evidence of vasculitis, non-perfusion areas and neovascularisation elsewhere. Systemic evaluation findings of positive Mantoux test, QuantiFERON Gold test and right apical pleuroparenchymal fibrosis observed on high-resolution CT of the chest were suggestive of postinfection probable tubercular aetiology. He was treated with oral steroids, antitubercular therapy, intravitreal bevacizumab and anterior retinal cryopexy, leading to resolution of vasculitis and vitreous haemorrhage. Later he developed peripheral retinal flap and posterior retinal breaks at 8-month and 11-month follow-up, respectively, which were managed by barrage laser. He maintained a stable visual acuity of 20/20, N6 for the next 2 years. He then presented with sudden decreased vision in the right eye (20/50, N10). Right eye fundus showed posterior pole retinal detachment with lifting of previously barraged posterior retinal breaks. He underwent vitreoretinal surgery with gas tamponade. Recent 1-month postoperative visit showed successful retinal reattachment and visual recovery of 20/20, N6.

Establishing the Diagnosis

2009 ◽  
Author(s):  
Daniel A. Brinton ◽  
Charles P. Wilkinson
Keyword(s):  
Retinal Detachment ◽  
Posterior Pole ◽  
Peripheral Retina ◽  
Retinal Breaks ◽  
Yellow Color ◽  
Red Color ◽  
The Central Nervous System ◽  
Retinal Artery ◽  
Ciliary Artery ◽  
Choroidal Vessels

The differential diagnosis of rhegmatogenous retinal detachment includes secondary (nonrhegmatogenous) retinal detachment and other entities that may simulate a retinal detachment. Nonrhegmatogenous detachments are categorized as exudative (serous) and tractional detachments. Conditions that may be mistaken for retinal detachment include retinoschisis, choroidal detachment or tumors, and vitreous membranes. Sometimes benign findings in the peripheral retina are mistaken for retinal breaks. The most prominent feature of the fundus is the optic nerve head or disc, the only place in the human body that affords a direct view of a tract of the central nervous system. The foveola, the functional center of the fundus, is located in the center of the fovea, which has a diameter of about 5°. The macula is centered on the fovea and has a diameter of about 17°. The multiple branches of the central retinal artery are readily identifi ed by their bright red color and relatively narrow caliber. The multiple tributaries of the central retinal vein are recognized by their dark red color and relatively wider caliber. In a darkly pigmented fundus, the choroidal vessels in the posterior pole can be obscured from view, but in an eye with minimal pigment, they are readily visible. The venous tributaries of the choroid that make up the vortex veins are usually easily seen. The most prominent features of the choroidal venous system are the vortex ampullae, of which there are usually four (but sometimes more). They are located approximately in the 1-, 5-, 7-, and 11-o’clock meridians, just posterior to the equator. The horizontal meridians are usually identifiable by their radially oriented, long posterior ciliary nerves, and infrequently the long posterior ciliary artery can be seen adjacent to the nerve. The nerve is relatively broad and has a yellow color, and the artery is identifiable by its red color. The artery is usually inferior to the nerve temporally, and superior to it nasally (Figure 5–1).

scholarly journals Surgical Management of a Patient with Anterior Megalophthalmos, Lens Subluxation, and a High Risk of Retinal Detachment

2017 ◽  
Vol 8 (1) ◽  
pp. 61-66 ◽  
Author(s):  
María Carmen Guixeres Esteve ◽  
Augusto Octavio Pardo Saiz ◽  
Lucía Martínez-Costa ◽  
Samuel González-Ocampo Dorta ◽  
Pedro Sanz Solana
Keyword(s):  
Retinal Detachment ◽  
Vision Loss ◽  
Lens Subluxation ◽  
Intraocular Lens Dislocation ◽  
Common Causes ◽  
History Of ◽  
Anterior Megalophthalmos ◽  
The Right ◽  
Iris Claw

The early development of lens opacities and lens subluxation are the most common causes of vision loss in patients with anterior megalophthalmos (AM). Cataract surgery in such patients is challenging, however, because of anatomical abnormalities. Intraocular lens dislocation is the most common postoperative complication. Patients with AM also seem to be affected by a type of vitreoretinopathy that predisposes them to retinal detachment. We here present the case of a 36-year-old man with bilateral AM misdiagnosed as simple megalocornea. He had a history of amaurosis in the right eye due to retinal detachment. He presented with vision loss in the left eye due to lens subluxation. Following the removal of the subluxated lens, it was deemed necessary to perform a vitrectomy in order to prevent retinal detachment. Seven months after surgery, an Artisan® Aphakia iris-claw lens was implanted in the anterior chamber. Fifteen months of follow-up data are provided.

scholarly journals Coats’ Retinitis or Retinoblastoma in a 3-Year-Old Girl: A Case Report

Medicina ◽  
2012 ◽  
Vol 48 (4) ◽  
pp. 32
Author(s):  
Alvydas Paunksnis ◽  
Daiva Imbrasienė ◽  
Rasa Liutkevičienė ◽  
Kristina Rilienė ◽  
Evaldas Keleras ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Abnormal Development ◽  
Eye Drops ◽  
Exudative Retinal Detachment ◽  
Hard Exudates ◽  
Appropriate Treatment ◽  
Department Of Ophthalmology ◽  
Coats Disease ◽  
The Right

Coats’ disease is an idiopathic disorder defined by an abnormal development of retinal vessels with a progressive deposition of intraretinal or subretinal exudates, leading to exudative retinal detachment. The most difficult task is to differentiate Coats’ disease from retinoblastoma. We present a rare case of Coats’ disease diagnosed in a 3-year-old girl. From the age of 6 months, the girl was followed up 2 times a year at the Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences, due to congenital convergent strabismus and refractive errors. At the age of 3.6 years, a routine examination of the fundus of the right eye revealed hard exudates, telangiectasia and tortuosity, gray color lesion below the optic nerve disc, submacular exudation in the inferior nasal part of the retina, and exudative retinal detachment, which extended from the 7-o’clock position to the 4-o’clock position. Before this examination, no abnormalities were found in the fundus of her both eyes. The girl was not treated with laser photocoagulation, cryocoagulation, or intravitreal injections, as the diagnosis of retinoblastoma could not be excluded; therefore, only eye drops were prescribed. In order to exclude the diagnosis of retinoblastoma, ultrasonography, magnetic resonance imaging, and computed tomography were carried out, and an appointment to see an ophthalmic oncologist was scheduled. Due to early and appropriate treatment, the progression of Coats’ disease in patients could be arrested. However, in some cases, when the diagnosis is ambiguous, it is better to follow up the patient and to treat only with eye drops.

Full-Thickness Macular Hole Formation After Repair of Rhegmatogenous and Tractional Retinal Detachment

2019 ◽  
Vol 3 (5) ◽  
pp. 341-345
Author(s):  
Matthew A. Cunningham ◽  
Samantha Fink ◽  
Jaya B. Kumar ◽  
Elias C. Mavrofrides ◽  
S.K. Steven Houston ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Case Series ◽  
Vitreoretinal Surgery ◽  
Visual Outcome ◽  
Full Thickness ◽  
Tractional Retinal Detachment ◽  
Full Thickness Macular Hole ◽  
Pars Plana

Purpose: This article reports the clinical features, associations, and outcomes of patients with full-thickness macular hole (MH) formation after pars plana vitrectomy for retinal detachment (RD). Methods: A retrospective, interventional case series is presented of consecutive patients undergoing surgical repair of MH following prior tractional or rhegmatogenous retinal detachment repair from September 2014 to October 2018 at a single vitreoretinal surgery practice. The size of the MH, presence of epiretinal membrane (ERM), rate of MH closure, and visual outcome following repair were evaluated. Results: A total of 996 cases of rhegmatogenous and tractional retinal detachment repair were identified. The average time from the RD surgery to MH diagnosis was 72 days. The incidence of subsequent MH formation in patients who underwent surgery was 0.8% (8/996). The presence of ERM prior to MH repair was noted in 50% of these cases (4/8). In cases with at least 3 months of postoperative follow-up, MH closure was achieved in 100% of eyes after a single surgery. The mean preoperative visual acuity (VA) was 2.06 logMAR (logarithm of the minimum angle of resolution) units (Snellen equivalent, 20/2296) and significantly improved to 0.72 logMAR units (Snellen, 20/104; P = .017) at the last follow-up after MH repair. All patients had improvement in VA at the final postoperative visit, with a VA of 20/200 or better achieved in 87.5% of cases. Conclusions: Although MH formation after successful RD repair is uncommon, favorable visual and anatomic results can be obtained.

Optical Coherence Tomography Angiography in idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome: A case report

2020 ◽  
pp. 112067212095759
Author(s):  
Meriem Ouederni ◽  
Hela Sassi ◽  
Zied Chelly ◽  
Fehmy Nefaa ◽  
Monia Cheour
Keyword(s):  
Optical Coherence Tomography ◽  
Optical Coherence Tomography Angiography ◽  
Retinal Vasculitis ◽  
Retinal Neovascularization ◽  
Optical Coherence ◽  
Fundus Fluorescein Angiography ◽  
Blurred Vision ◽  
Additional Tool ◽  
The Right

Purpose: Since its first description by Chang et al. in 1995, the diagnosis of Idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome has been based on the findings of Fundus Fluorescein Angiography (FFA). Our purpose was to describe the utility of optical coherence tomography angiography (OCT-A) in its diagnosis and management. Case description: A 40-year-old female presented with bilateral blurred vision. Her best corrected visual acuity was at 8/10. Fundus examination revealed blurred disc margins, perivascular exudates, arterial sheaths and retinal hemorrhages bilaterally. FFA showed staining of the optic disc with dye leakage in the right eye, a punctuate hyperfluorescence of the temporosuperior artery in the left eye, bilateral vascular sheathing and capillary dropout. OCT-A showed simultaneous presence of papillary aneurysm and neovascularization of the optic nerve head in the right eye, a papillary aneurysm in the left eye and bilateral capillary non-perfusion. Our patient was diagnosed with IRVAN syndrome. Oral steroids associated with panretinal laser photocoagulation and intravitreal injection of bevacizumab in the right eye resulted in vanishing of the papillary neovascularization with no recurrence on OCT-A at 10-month follow-up. Conclusions: OCT-A is an additional tool to FFA for visualization of arterial macroaneurysms and retinal neovascularization without the interference of dye leakage. It well demarcates nonperfused areas and ensures follow-up of retinal neovascularization. Its limitations are the limited field of view and the low sensitivity in detecting arteriolar dilations. Thus, OCT-A is unable to outplace FFA but should be considered alternately with it for non-invasive follow-up of IRVAN syndrome.

Vitreoretinal Surgery for Retinal Detachment in Retinochoroidal Colobomata

2008 ◽  
Vol 18 (2) ◽  
pp. 304-308 ◽  
Author(s):  
S.C.B. Teoh ◽  
E.J. Mayer ◽  
R.J. Haynes ◽  
R.H.B. Grey ◽  
A.D. Dick ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Silicone Oil ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Hand Movement ◽  
Vitreoretinal Surgery ◽  
Scleral Buckling ◽  
Tertiary Referral Center ◽  
Near Work

Purpose To report the management and outcome of retinal reattachment surgery in retinochoroidal coloboma. Methods Four patients with retinochoroidal colobomata presented to the Bristol Eye Hospital (a UK tertiary referral center for vitreoretinal surgery) with retinal detachment. INTERVENTION. All were type II colobomatous detachments (three patients with type IIB, one patient with type IID). All eyes underwent vitrectomy with endolaser and/or cryotherapy and three eyes underwent scleral buckling. Two eyes had internal tamponade with gas (SF6, C3F8) while the other two had silicone oil. Endolaser was applied over healthy retinal pigment epithelium. Results At last follow-up, all (100%) remained attached, with no recurrences. Three patients achieved visual acuity of 6/120 or better and were able to perform satisfactory near work with appropriate magnifiers. The last patient began with hand movement vision and retained similar vision but subjectively felt more navigational. Conclusions Good anatomic and functional outcomes can be achieved in this patient group with combined vitrectomy with or without scleral buckling surgery. Endolaser retinopexy is effective over healthy RPE at the margin of the coloboma combined with either gas or oil internal tamponade.

Unusual presentation of early-onset X-linked retinoschisis: Report after 1 year of multimodal follow-up

2020 ◽  
pp. 112067212091672
Author(s):  
Andrea Lembo ◽  
Giacomo Maria Bacci ◽  
Massimiliano Serafino ◽  
Stefano Lucentini ◽  
Roberto Caputo ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Early Onset ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Retinal Dystrophy ◽  
Unusual Presentation ◽  
Macular Dystrophy ◽  
Wide Field ◽  
The Right

Purpose: To describe the unusual presentation, diagnosis, and clinical course of an early-onset X-linked infantile retinoschisis Case report: A 6-month-old infant presented with strabismus and poor fixation. After the detection of bilateral intraretinal hemorrhage and diffuse dystrophic retinal pattern at indirect ophthalmoscopy, the patient received a complete evaluation under anesthesia. Retinal wide-field imaging, spectral domain optical coherence tomography, and electroretinogram were performed and revealed a retinoschisis involving the posterior pole and the inferior periphery in the right eye. In the left eye, an inferior retinal detachment extending to the macula was detected. Blood sample and genetic counseling were required in the strong suspicion of an inherited retinal dystrophy. Genetic tests confirmed the diagnosis of X-linked retinoschisis (RS1 gene mutation). After consultation with a pediatric vitreoretinal surgeon, a wait and see strategy was chosen. The follow up visits showed a surprisingly good natural course of the disease. Conclusion: X-linked retinoschisis is a well-known inherited retinal disease potentially affecting young children as early as 3 months old. In this case, the stunning presentation (diffuse retinal pigment epithelium dystrophic changes resembling a macular dystrophy) and the positive course of the disease (resolution of macular retinal detachment in the left eye and stability of schisis in the right eye) arise some interesting considerations about the necessity of an early surgical treatment.

Retinal vasoproliferative tumour secondary to retinitis pigmentosa sine pigmento

2021 ◽  
Vol 14 (5) ◽  
pp. e240878
Author(s):  
Albert John Bromeo ◽  
Sweet Jorlene Lerit ◽  
Amadeo Veloso ◽  
Gary John Mercado
Keyword(s):  
Retinal Detachment ◽  
Retinitis Pigmentosa ◽  
Laser Photocoagulation ◽  
Vision Loss ◽  
Peripheral Retina ◽  
Focal Laser Photocoagulation ◽  
Feeder Vessel ◽  
Eye Examination ◽  
The Right

Retinitis pigmentosa can be associated with exudative vasculopathy in rare instances, which can manifest as retinal vasoproliferative tumours. We present the case of a 33-year-old woman previously diagnosed with retinitis pigmentosa sine pigmentosa in both eyes. She was asymptomatic and just came in for a routine follow-up eye examination. Thorough examination of the peripheral retina on the right eye revealed a dome-shaped retinal tumour with a feeder vessel and surrounding exudative changes at the superotemporal periphery, consistent with a secondary retinal vasoproliferative tumour from retinitis pigmentosa. She subsequently underwent focal laser photocoagulation of the tumour which resulted in tumour stabilisation. While exudative vasculopathy is very uncommon in retinitis pigmentosa, ophthalmologists need to be aware of its occurrence in such patients. Vision loss may occur from exudation, haemorrhage, retinal detachment and neovascularisation. A thorough examination of the peripheral retina is warranted in these cases.

scholarly journals Autologous internal limiting membrane flap for retinal detachment due to posterior retinal tears over choroidal atrophy in highly myopic eyes

2018 ◽  
Vol 103 (8) ◽  
pp. 1133-1136 ◽  
Author(s):  
Tommaso Rossi ◽  
Tomaso Caporossi ◽  
Stanislao Rizzo ◽  
Carlandrea Trillo ◽  
Serena Telani ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Internal Limiting Membrane ◽  
Control Group ◽  
Retinal Breaks ◽  
Pars Plana ◽  
Anatomical Success ◽  
Anatomical Success Rate

PurposeTo review a series of highly myopic eyes with retinal detachment undergoing pars plana vitrectomy with autologous internal limiting membrane (ILM) flap placed over posterior retinal breaks located in areas of choroidal atrophy.MethodsRetrospective review of 13 consecutive patients receiving pars plana vitrectomy with ILM flap over causative breaks, compared with 19 controls receiving the same surgery with ILM peeling but no ILM flap. Main outcome measures included anatomical success rate, visual acuity, number of surgeries and the rate of silicone oil removal.ResultsPatients in the ILM group required 2.08±0.37 interventions versus 2.58±0.75 in the control group (p=0.037). One (1/13; 7.6%) patient in the ILM group required additional unplanned surgery versus 8/19 (42.10%) in the control group (p=0.038). Final anatomical success rate defined as attached retina after silicone oil (SiO) removal was 13/13 in the I-ILM group and 14/19 (73.6%) in the control group (p=0.052). No patients (0/13) in the I-ILM group retained SiO at the end of follow-up versus 4/19 (21.1%) patients in the control group (p=0.061). Best-corrected visual acuity at the end of follow-up was logMAR 0.65±0.36 (20/91 Snellen) in the ILM group and logMAR 0.89±0.44 (20/158 Snellen) in the control group (p=0.20).ConclusionAutologous ILM may help seal posterior retinal breaks and improve the surgical prognosis of retinal detachment due to breaks located over areas of choroidal atrophy within the myopic staphyloma.

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