Background: We report a case showing good visual recovery after remarkable decreased visual acuity through surgical repair of full-thickness macular retinal fold after vitrectomy for rhegmatogenous retinal detachment (RRD).
Case: A 41-year-old man visited a nearby clinic with chief complaints of visual field defect and decreased visual acuity in his right eye and was diagnosed with RRD. He was then referred to our hospital for surgical treatment. At the time of his initial visit to our hospital, the best-corrected visual acuity in his right eye was 0.4 and the intraocular pressure was 13 mmHg. There were no abnormalities in the anterior segment of both eyes, but mild cataracts were observed in the optic media of both eyes. Two horseshoe-shaped retinal breaks in the superior peripheral area and a concomitant bullous RRD in the upper retina with macular involvement was observed in the right fundus. The left eye indicated lattice degeneration in the peripheral retina. On the day after the initial visit, vitrectomy of the right eye was performed using a 25-gauge cutter, and subretinal fluid was aspirated from the original retinal breaks without creating an intentional retinal hole. After fluid-air exchange, laser photocoagulation was performed around the retinal breaks, and no expansile gas or silicone oil was used. The patient was kept in a prone position until the next day, after which he was postured in an upright position. On postoperative day 5, the patient reported a linear scotoma across his central vision, and visual corre c ted acuity in his right eye decreased to 0.07. Although the retina was reattached, a full-thickness macular retinal fold was observed. Despite placing the patient in a prone position for monitoring overnight, the macular retinal fold remained. On postoperative day 6, vitrectomy with a subretinal injection of balanced saline solution (BSS) was administered, followed by flattening the retinal fold by fluid-air exchange and perfluorocarbon liquid, and filling with 20% sulfur hexafluoride 6 gas. Thereafter, the macular retinal fold was almost resolved, and his visual acuity in his right eye recovered to 1.0.
Conclusion: Vitrectomy with subretinal injection of BSS was effective for the treatment of macular retinal fold after RRD repair.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 100-108,2023.