Retinal Dehydration Injury after Vitrectomy with Gas - Also subretinal perfluoron
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49-year-old man was seen in the office on December 28, 2011. He had photorefractive keratectomy in both eyes for his myopia and then he had developed a retinal detachment in the left eye. He had that repaired up in Atlanta August 30th of 2010. He had a scleral buckle, vitrectomy, laser and gas in the left eye and also after examining we can tell that perfluoron was used at the time of surgery. He developed a cataract after the surgery, but even before the cataract surgery he did notice blind spots in the center of the left eye and then after the cataract surgery his vision has been disappointing. The left eye is his mono vision eye. He uses it up close. When he looks at things he has a central scotoma. He also notices a dense, inferior visual field defect. His vision in the right eye is good. He does notice some new floaters in the right eye though.
VISUAL ACUITY: OD 20/20, OS 20/50. IOP: OD 13, OS 10. Color vision is normal in both eyes.
SLIT EXAMINATION: The right eye has 2+ nuclear sclerosis. The left eye has a posterior chamber intraocular lens in good position with open capsule.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.0. The nerve looks a little small. There is no posterior vitreous separation with scleral depression and no retinal tears. There was a small cluster of bear track congenital hypertrophy of the retinal pigment epithelial lesions, which were tiny. There were four of them in a string at about 5 o’clock straddling the equator and then there is a single one just posterior to the equator at 7 o’clock.
OS: Vertical C/D ratio is 0.1. The vitreous is empty. There is a drop of subretinal perfluoron just abutting the nasal edge of the optic nerve. It is about 1000 microns across. There looks to be a 1+ epiretinal membrane. The retina is attached on a moderate buckle with peripheral laser and also a little bit of posterior laser inferonasally.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye was normal. The left eye however, does show inner retinal atrophy just on the superior half of the macula corresponding to his visual field defect with loss of the nerve fiber layer in the superior half of the macula.
IMPRESSION:
1. INNER RETINAL ATROPHY POST MACULA-ON RETINAL DETACHMENT SURGERY – LEFT EYE
2. SUBRETINAL PERFLUORON – LEFT EYE
3. BEAR TRACKS – RIGHT EYE
DISCUSSION: I explained to the patient there is evidence of inner retinal damage in the left eye, which does sometimes occur in patients who have had any vitrectomy surgery with air. As I was discussing with you, there are two competing theories as to why this occurs, one is the retina becomes dehydrated and there is damage to the inner retina and the other one is that there is force damage from the air infusion at the time of surgery. The defects are almost always inferiorly and it has been noted that when the infusion is moved, the damage does occur opposite the infusion cannula. Unfortunately there is no known treatment for this at the moment and the defects generally are stable.
His foveal OCT scan looks completely normal as far as the photoreceptors go, so I don’t have a good explanation for the decreased central vision, although it is possible there is enough inner retinal damage, the signal from that area of the retina is not get through as well as it should. Either way at this point I don’t think any further treatments are appropriate in the left eye. The subretinal perfluoron I don’t think is adversely affecting his visual function in any way. It doesn’t map to where he is having his vision problem.
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron651 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron542 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron616 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron612 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron559 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron543 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron682 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron495 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron567 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Video - TAKES TIME TO LOAD - Normal Retina506 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron577 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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VIDEO - Takes a LONG TIME TO LOAD - Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron512 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron623 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron587 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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Dehydration Injury to Retina after Macula-On Retinal Detachment Repair - Also Subretinal Perfluoron703 views18 month ago he had a scleral buckle, vitrectomy, laser and gas for macula on retinal detachment. Since he notices blind spots in the center of the left eye/ He also notices a dense, inferior visual field defect. OD 20/20, OS 20/50
(0 votes)
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49-year-old man was seen in the office on December 28, 2011. He had photorefractive keratectomy in both eyes for his myopia and then he had developed a retinal detachment in the left eye. He had that repaired up in Atlanta August 30th of 2010. He had a scleral buckle, vitrectomy, laser and gas in the left eye and also after examining we can tell that perfluoron was used at the time of surgery. He developed a cataract after the surgery, but even before the cataract surgery he did notice blind spots in the center of the left eye and then after the cataract surgery his vision has been disappointing. The left eye is his mono vision eye. He uses it up close. When he looks at things he has a central scotoma. He also notices a dense, inferior visual field defect. His vision in the right eye is good. He does notice some new floaters in the right eye though.
VISUAL ACUITY: OD 20/20, OS 20/50. IOP: OD 13, OS 10. Color vision is normal in both eyes.
SLIT EXAMINATION: The right eye has 2+ nuclear sclerosis. The left eye has a posterior chamber intraocular lens in good position with open capsule.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.0. The nerve looks a little small. There is no posterior vitreous separation with scleral depression and no retinal tears. There was a small cluster of bear track congenital hypertrophy of the retinal pigment epithelial lesions, which were tiny. There were four of them in a string at about 5 o’clock straddling the equator and then there is a single one just posterior to the equator at 7 o’clock.
OS: Vertical C/D ratio is 0.1. The vitreous is empty. There is a drop of subretinal perfluoron just abutting the nasal edge of the optic nerve. It is about 1000 microns across. There looks to be a 1+ epiretinal membrane. The retina is attached on a moderate buckle with peripheral laser and also a little bit of posterior laser inferonasally.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye was normal. The left eye however, does show inner retinal atrophy just on the superior half of the macula corresponding to his visual field defect with loss of the nerve fiber layer in the superior half of the macula.
IMPRESSION:
1. INNER RETINAL ATROPHY POST MACULA-ON RETINAL DETACHMENT SURGERY – LEFT EYE
2. SUBRETINAL PERFLUORON – LEFT EYE
3. BEAR TRACKS – RIGHT EYE
DISCUSSION: I explained to the patient there is evidence of inner retinal damage in the left eye, which does sometimes occur in patients who have had any vitrectomy surgery with air. As I was discussing with you, there are two competing theories as to why this occurs, one is the retina becomes dehydrated and there is damage to the inner retina and the other one is that there is force damage from the air infusion at the time of surgery. The defects are almost always inferiorly and it has been noted that when the infusion is moved, the damage does occur opposite the infusion cannula. Unfortunately there is no known treatment for this at the moment and the defects generally are stable.
His foveal OCT scan looks completely normal as far as the photoreceptors go, so I don’t have a good explanation for the decreased central vision, although it is possible there is enough inner retinal damage, the signal from that area of the retina is not get through as well as it should. Either way at this point I don’t think any further treatments are appropriate in the left eye. The subretinal perfluoron I don’t think is adversely affecting his visual function in any way. It doesn’t map to where he is having his vision problem.
