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15-year-old was seen in the office on September 21, 2009. He had a slowly developing cataract in the left eye over about the last three years. His cataract was already dense when it was removed August 3rd of 2009. The preoperative ultrasound suggested the retina might be abnormal and then once the retina was detached, it was clear that he had a retinal detachment. Because of the amount of scarring the retina was impossible to unfold and it was reattached in a closed funnel formation. He comes in with poor vision in the eye with an interest of whether anything else could or should be done for the left eye. There is also a question of an outstanding biopsy of some sort of a mass in the back of the eye, which still needs to be reported on. He is not to his knowledge had any trauma or infection in the eye and he believes the eye was not congenitally abnormal though. It sounds like it may have been a persistent hyperplastic primary vitreous eye. He is on Xibrom and Pred Forte in the left eye twice a day. VISUAL ACUITY: OD 20/30, OS: NLP. IOP: OD 16, OS 9. SLIT EXAMINATION: The right eye is normal with clear lens. The left eye has iris Bombay. The angle is very narrow and the posterior chamber intraocular lens is centered. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. The macula and periphery look healthy. OS: The retina is in a closed funnel configuration extending superonasally off the optic nerve and it is flat against the back wall of the eye under silicone oil. Photos confirm clinical findings. IMPRESSION: 1. CLOSED FUNNEL RETINAL DETACHMENT – LEFT EYE PUSHED AGAINST THE EYE WALL UNDER SILICONE OIL 2. NO LIGHT PERCEPTION. – LEFT EYE DISCUSSION: I explained to the patient and the father that unfortunately no light perception vision, the chance of recovering vision in the eye even with the unlikely chance the retina could be reattached is zero and therefore because of the risks of sympathetic ophthalmia and further invasive procedures adversely affecting the other eye the standard of care in this situation is to pursue no further surgery other than anything that will help with cosmetics and comfort. At this moment he does have a little bit of an exotropia and he would like something to be done about that at some point and I think probably a contact lens would be the first thing that could be done within a few months once the eye quiets down from the surgery. In the meantime I asked him to continue his Xibrom and Pred Forte drops.

funnelrd_phba01.png
Closed Funnel Retinal Detachment Under Silicone Oil - NLP Vision (20/30 Fellow Eye)240 views15-year-old slowly developing cataract in the left eye over about the last three years. His cataract was already dense when it was removed August 3rd of 2009. The preoperative ultrasound suggested the retina might be abnormal and then once the retina was detached, it was clear that he had a retinal detachment. Because of the amount of scarring the retina was impossible to unfold and it was reattached in a closed funnel formation.

VISUAL ACUITY: OD 20/30, OS: NLP.
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Closed Funnel Retinal Detachment Under Silicone Oil - NLP Vision343 views15-year-old slowly developing cataract in the left eye over about the last three years. His cataract was already dense when it was removed August 3rd of 2009. The preoperative ultrasound suggested the retina might be abnormal and then once the retina was detached, it was clear that he had a retinal detachment. Because of the amount of scarring the retina was impossible to unfold and it was reattached in a closed funnel formation.

VISUAL ACUITY: OD 20/30, OS: NLP.
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Closed Funnel Retinal Detachment Under Silicone Oil - NLP Vision168 views15-year-old slowly developing cataract in the left eye over about the last three years. His cataract was already dense when it was removed August 3rd of 2009. The preoperative ultrasound suggested the retina might be abnormal and then once the retina was detached, it was clear that he had a retinal detachment. Because of the amount of scarring the retina was impossible to unfold and it was reattached in a closed funnel formation.

VISUAL ACUITY: OD 20/30, OS: NLP.
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funnelrd_phba04.png
Closed Funnel Retinal Detachment Under Silicone Oil - NLP Vision168 views15-year-old slowly developing cataract in the left eye over about the last three years. His cataract was already dense when it was removed August 3rd of 2009. The preoperative ultrasound suggested the retina might be abnormal and then once the retina was detached, it was clear that he had a retinal detachment. Because of the amount of scarring the retina was impossible to unfold and it was reattached in a closed funnel formation.

VISUAL ACUITY: OD 20/30, OS: NLP.
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funnelrd_phba05.png
Closed Funnel Retinal Detachment Under Silicone Oil - NLP Vision139 views15-year-old slowly developing cataract in the left eye over about the last three years. His cataract was already dense when it was removed August 3rd of 2009. The preoperative ultrasound suggested the retina might be abnormal and then once the retina was detached, it was clear that he had a retinal detachment. Because of the amount of scarring the retina was impossible to unfold and it was reattached in a closed funnel formation.

VISUAL ACUITY: OD 20/30, OS: NLP.
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Closed Funnel Retinal Detachment Under Silicone Oil - NLP Vision - Macular with Bare Retinal Pigment Epithelium142 views15-year-old slowly developing cataract in the left eye over about the last three years. His cataract was already dense when it was removed August 3rd of 2009. The preoperative ultrasound suggested the retina might be abnormal and then once the retina was detached, it was clear that he had a retinal detachment. Because of the amount of scarring the retina was impossible to unfold and it was reattached in a closed funnel formation.

VISUAL ACUITY: OD 20/30, OS: NLP.
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15-year-old was seen in the office on September 21, 2009. He had a slowly developing cataract in the left eye over about the last three years. His cataract was already dense when it was removed August 3rd of 2009. The preoperative ultrasound suggested the retina might be abnormal and then once the retina was detached, it was clear that he had a retinal detachment. Because of the amount of scarring the retina was impossible to unfold and it was reattached in a closed funnel formation. He comes in with poor vision in the eye with an interest of whether anything else could or should be done for the left eye. There is also a question of an outstanding biopsy of some sort of a mass in the back of the eye, which still needs to be reported on. He is not to his knowledge had any trauma or infection in the eye and he believes the eye was not congenitally abnormal though. It sounds like it may have been a persistent hyperplastic primary vitreous eye. He is on Xibrom and Pred Forte in the left eye twice a day. VISUAL ACUITY: OD 20/30, OS: NLP. IOP: OD 16, OS 9. SLIT EXAMINATION: The right eye is normal with clear lens. The left eye has iris Bombay. The angle is very narrow and the posterior chamber intraocular lens is centered. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. The macula and periphery look healthy. OS: The retina is in a closed funnel configuration extending superonasally off the optic nerve and it is flat against the back wall of the eye under silicone oil. Photos confirm clinical findings. IMPRESSION: 1. CLOSED FUNNEL RETINAL DETACHMENT – LEFT EYE PUSHED AGAINST THE EYE WALL UNDER SILICONE OIL 2. NO LIGHT PERCEPTION. – LEFT EYE DISCUSSION: I explained to the patient and the father that unfortunately no light perception vision, the chance of recovering vision in the eye even with the unlikely chance the retina could be reattached is zero and therefore because of the risks of sympathetic ophthalmia and further invasive procedures adversely affecting the other eye the standard of care in this situation is to pursue no further surgery other than anything that will help with cosmetics and comfort. At this moment he does have a little bit of an exotropia and he would like something to be done about that at some point and I think probably a contact lens would be the first thing that could be done within a few months once the eye quiets down from the surgery. In the meantime I asked him to continue his Xibrom and Pred Forte drops.