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61-year-old man was seen in the office on December 16, 2010. I appreciate your note, which was helpful. He had an episode twelve days ago, where he was playing tennis, he was hit in the left eye. He was actually hitting the tennis ball off a wall and hit himself in the left eye and subsequent to that his vision was good, but then he saw a shadow and then it looked like he was looking through a glass of water out of the left eye. You saw a retinal detachment. You also saw the posterior synechiae and suggest he come here for an evaluation. His right eye is fine. He is myopic. He is about a -4 myope in the right eye. VISUAL ACUITY: OD 20/25, OS 3/200. IOP: OD 11, OS 15. SLIT EXAMINATION: The right eye has 1+ nuclear sclerosis. The left eye does have a posterior synechiae at 2 o’clock and trace cell in the anterior chamber and 1+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is posterior vitreous separation with scleral depression. There is a retinal detachment from 6 o’clock to 7 o’clock extending 2 disc-diameters posterior the equator with a retinal tear at 7. There are also two small retinal tears at 11 o’clock and then another large retinal tear at 12 o’clock with a retinal detachment superotemporally extending from 10 o’clock to 12 o’clock, about 4 disc-diameters posterior to the equator. OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a total retinal detachment with a tiny retinal tear at 2 o’clock. There is lattice degeneration at 6 with two holes in it. There is also a retinal hemorrhage at 3 o’clock, possibly from the injury. IMPRESSION: 1. BILATERAL RETINAL DETACHMENTS 2. TRAUMA – LEFT EYE 3. POSTERIOR SYNECHIAE – LEFT EYE 4. RETINAL HEMORRHAGE – LEFT EYE 5. MILD CATARACTS DISCUSSION: I explained to the patient he does have retinal detachments in both eyes. The left eye I believe at this point is the more urgent eye, because the retina is totally detached and has been so probably for a week or two. Although the right eye is also urgent, because it is a macula-on retinal detachment. I told him it is generally medically inadvisable to operate on both eyes at once, because the possible complications and therefore I have him scheduled him for surgery in the left eye today and then depending on how things go, hopefully we will do the right eye next week. In the meantime I warned him that activity does sometimes cause progression of retinal detachments and the best that he can just do is just lay around the house and watch T.V., which will help prevent progression of the retinal detachment in the right eye and probably help the left eye to settle nicely as well. I told him about the different procedures. It is possible to do a scleral buckle and or a vitrectomy. Given that he is phakic and all the pathologies anterior and the retinal detachments are fairly shallow in the left eye, I suggest we go ahead with the scleral buckle, which has about an 80 to 85 percent one operation success rate, which has about a 60 to 70 percent of substantially improving his vision to 20/40 or better. I have him scheduled for surgery in the left eye today. I warned him about the risks, benefits, and alternatives to surgery. I will keep you abreast of his progress. Follow-up 1 year later: 61-year-old man had a macula-on retinal detachment repair in the right eye and a macula-off retinal detachment repair in the left eye, both one year ago. His vision in the left eye is poor. He still has a lot of floaters in both eyes. VISUAL ACUITY: OD 20/25, OS 20/50

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Pre-operative photograph - macula off, 3/200 retinal detachment165 views61-year-old man decreased vision left eye for 2 weeks.

VISUAL ACUITY: OD 20/25, OS 3/200
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Pre-operative photograph - macula off, 3/200 retinal detachment145 views61-year-old man decreased vision left eye for 2 weeks.

VISUAL ACUITY: OD 20/25, OS 3/200
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Post-operative photography - vision has improved to 20/50 1 year later.193 views1 year after scleral buckle vision is 20/50 and patient has a cataract.00000
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Pre-operative photograph - macula off, 3/200 retinal detachment161 views61-year-old man decreased vision left eye for 2 weeks.

VISUAL ACUITY: OD 20/25, OS 3/200
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61-year-old man was seen in the office on December 16, 2010. I appreciate your note, which was helpful. He had an episode twelve days ago, where he was playing tennis, he was hit in the left eye. He was actually hitting the tennis ball off a wall and hit himself in the left eye and subsequent to that his vision was good, but then he saw a shadow and then it looked like he was looking through a glass of water out of the left eye. You saw a retinal detachment. You also saw the posterior synechiae and suggest he come here for an evaluation. His right eye is fine. He is myopic. He is about a -4 myope in the right eye. VISUAL ACUITY: OD 20/25, OS 3/200. IOP: OD 11, OS 15. SLIT EXAMINATION: The right eye has 1+ nuclear sclerosis. The left eye does have a posterior synechiae at 2 o’clock and trace cell in the anterior chamber and 1+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is posterior vitreous separation with scleral depression. There is a retinal detachment from 6 o’clock to 7 o’clock extending 2 disc-diameters posterior the equator with a retinal tear at 7. There are also two small retinal tears at 11 o’clock and then another large retinal tear at 12 o’clock with a retinal detachment superotemporally extending from 10 o’clock to 12 o’clock, about 4 disc-diameters posterior to the equator. OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a total retinal detachment with a tiny retinal tear at 2 o’clock. There is lattice degeneration at 6 with two holes in it. There is also a retinal hemorrhage at 3 o’clock, possibly from the injury. IMPRESSION: 1. BILATERAL RETINAL DETACHMENTS 2. TRAUMA – LEFT EYE 3. POSTERIOR SYNECHIAE – LEFT EYE 4. RETINAL HEMORRHAGE – LEFT EYE 5. MILD CATARACTS DISCUSSION: I explained to the patient he does have retinal detachments in both eyes. The left eye I believe at this point is the more urgent eye, because the retina is totally detached and has been so probably for a week or two. Although the right eye is also urgent, because it is a macula-on retinal detachment. I told him it is generally medically inadvisable to operate on both eyes at once, because the possible complications and therefore I have him scheduled him for surgery in the left eye today and then depending on how things go, hopefully we will do the right eye next week. In the meantime I warned him that activity does sometimes cause progression of retinal detachments and the best that he can just do is just lay around the house and watch T.V., which will help prevent progression of the retinal detachment in the right eye and probably help the left eye to settle nicely as well. I told him about the different procedures. It is possible to do a scleral buckle and or a vitrectomy. Given that he is phakic and all the pathologies anterior and the retinal detachments are fairly shallow in the left eye, I suggest we go ahead with the scleral buckle, which has about an 80 to 85 percent one operation success rate, which has about a 60 to 70 percent of substantially improving his vision to 20/40 or better. I have him scheduled for surgery in the left eye today. I warned him about the risks, benefits, and alternatives to surgery. I will keep you abreast of his progress. Follow-up 1 year later: 61-year-old man had a macula-on retinal detachment repair in the right eye and a macula-off retinal detachment repair in the left eye, both one year ago. His vision in the left eye is poor. He still has a lot of floaters in both eyes. VISUAL ACUITY: OD 20/25, OS 20/50