NEWS & EVENTS
Retinal Review, Issue 56
An 18 year old man was elbowed in the left eye during a basketball game earlier in the day. He noted immediate central and peripheral vision loss. Past ocular history is significant for emmetropia. Past medical history is negative. On examination VA was OD: 20/20 and OS: 20/60. IOP was OD: 15 and OS: 9. The SLE was quiet OD; there was a moderate iriits OS. DFE was normal OD. In OS there was a moderate vitreous hemorrhage. The retinal photos are shown below:
The right eye was normal. In the left eye there was vitreous hemorrhage peripherally and posteriorly. There was retinal edema in the macula (Berlin’s edema) and the periphery (commotion retinae). There was a superotemporal retinal dialysis with localized retinal detachment extending beyond the equator but not up to the macula. These are typical retinal findings associated with blunt ocular trauma. Traumatic iritis is common and is generally treated with topical steroid and cycloplegic. It usually resolves within a week. Retinal edema is also common. It also usually resolves within a week. RPE disease can remain but vision usually recovers. If a patient develops a retinal break from blunt trauma, it is usually a retinal dialysis (retinal disinsertion from the vitreous base). The most common quadrants for a retinal dialysis are inferotemporal and superonasal. They can be difficult to see and often can only be seen with scleral depression. If a dialysis (or tear) is diagnosed before the retina detaches, it can be repaired with laser or cryopexy. In our patient, he had already detached by the time we saw him later that day – this is atypical but his trauma was extensive.
Options for repairing a superotemporal retinal detachment include laser, pneumatic retinopexy, scleral buckle, and vitrectomy. Laser is the simplest and can be performed if the fluid is minimal. Our patient’s fluid was beyond the point where laser would have been successful. Although pneumatic retinopexy is not typically advised in a young patient who has not had a PVD, we elected to try this procedure. The procedure is quick, relatively painless, and with a rapid recovery. Because the tear was in the superior quadrant and no other retinal thinning was noted, we thought we would give it a try. The worst case scenario would be that it wouldn’t work and we would then go on to either scleral buckle or vitrectomy
The pneumatic retinopexy worked well. As noted in the photograph two days after the gas injection, the retina was flat with a 20% superior gas bubble. There was persistent Berlin’s edema and commotion retinae. Vision was still 20/50.
Over the next two weeks the gas bubble slowly dissolved, the retinal edema resolved, and the retina remained flat. His vision recovered back to 20/20 with no further issues. He has been seen yearly for the past two years and has remained stable. Please see photos below (ignore artifacts). This case demonstrates that rapid attention to a traumatic retinal break and detachment can result in a good outcome. It further demonstrates that pneumatic retinopexy can be used successfully in certain selected traumatic detachments.
Dr. Burton Wisotsky
Dr. Danielle Strauss
Dr. George Veliky (Iselin office)
Dr. Mike Veliky (Rochelle Park office)
Dr. Allison LaFata (West Orange office)
Dr. Nazreen Esack (Parsippany office)
Ann Lacey (Marketing Director)