Maurice F. Rabb » Retinal Detachment Of The Macula

A 65 year old Caucasian male, was in good ocular health with only a moderate correction for hyperopia until two days prior to admission. He noted the onset of a positive central scotoma in the right eye. He was diagnosed as "retinal detachment" and referred for surgical management.

Upon examination, the right eye was found to have vision of counting fingers only. The anterior segment was normal. There was very prominent retinoschisis with a giant break at the posterior limit of the outer wall of retinoschisis and this passed within the macula. The break covered an area greater than 90 degrees. The SUbretinal fluid included the macula. The anterior edge of the break was rolled over in an anterior direction.
The contralateral eye had bar light perception from problems of retinoschisis, retinal detachment and intractable glaucoma.

The patient was managed with 48 hours of bilateral patching during which there was considerable settling of the retinal detachment. The para-foveal area of the retina was then treated with rather intensive laser therapy and the patient was immediately taken to the operating room and then the remainder of the schisis cavity was treated with contiguous applications of cryotherapy. A vitrectomy was then carried out. This resulted in a permanent reattachment of the retina with sealing of the giant tear. The patient has done quite well post operatively. The vision has recovered to a level of 20/40 and there are no apparent complications.