NEWS & EVENTS
Retinal Review, Issue 31
CASE NUMBER 31
A thirteen year old boy was referred for vision loss in his right eye. He noted poor vision in the right eye one year before. He reported it to his mother who reported the problem to his pediatrician. An ocular examination at that time was reportedly unremarkable. The patient was subsequently referred to a neurologist for evaluation for possible neurologic disease with associated vision loss. The neurologist found no abnormalities. The patient continued to complain about poor vision and was then admitted to the psychiatric ward at a local hospital for evaluation for psychiatric issue and potential malingering. He was discharged and told that he was psychiatrically intact. Months later he brought up the problem again to his mother who then brought him to his optometrist. He was subsequently referred to us for further evaluation. On examination visual acuity was OD: LP and OS: 20/20. IOP’s were OD: 2 and OS: 15. There was chronic anterior segment inflammation OD and a dense white cataract. The anterior segment of OS was normal. Dilated examination of OS was normal. There was no view of the retina of the right eye due to the dense cataract and vitreous hemorrhage. Bscan of the right eye showed dense vitreous hemorrhage with total retinal detachment.
The patient was diagnosed with a chronic retinal detachment in his right eye with associated cataract, vitreous hemorrhage, anterior segment inflammation, and hypotony. The bscan suggested that the retina was stiff from chronic detachment and overlying fibrosis (proliferative vitreoretinopathy, or PVR). We explained to the patient’s mother that the prognosis was poor given the chronic nature of the detachment. Reattachment rate with surgery would only be 50% and even if the retina is reattached, vision would likely be poor. Additionally multiple procedures might be necessary to reattach the retina. The patient and his mother were willing to try anything to try to restore vision so we scheduled surgery. He underwent sclera buckle, pars plana vitrectomy, lensectomy, membrane peeling, retinal reattachment, endolaser, and silicone oil injection. The surgery was long and difficult, but luckily the fibrotic tissue peeled off well and the retina was reattached. It has remained attached under the silicone oil for four months after surgery. With a slight hyperopic correction, the vision to our amazement has improved to 20/60. Below are photos of the postoperative appearance. The central “artifact” is actually a reflection off the silicone oil. The retina is completely flat with extensive peripheral laser over the scleral buckle.
Our patient had a remarkable outcome. He will likely undergo removal of silicone oil with secondary ACIOL in a few months. For now he and his mother are grateful that he can see again.