Author: Sandra Pérez García (Spain)
Co-authors: Ruth Abárzuza Cotaire, Nerea Zubieta Gonzalo, Sara Mosquera Pedreiro, Pablo Plaza Ramos, Luís Ansa Echegaray, Juan Ferreiro López
To report a case of a serous retinal detachment, in absence of clinically detectable retinal breaks, noticed the day after ERM surgery and with spontaneous resolution.
Idiopathic ERM surgery by vitrectomy with ERM removal associated with ILM peeling is a safety and effective procedure. Nonetheless, well-known complications are iatrogenic retinal tears, which can be develop during the surgery; the most common are peripheral ones, with an incidence of 5 to 6%. Alternatively, breaks can also appear in posterior pole, with an incidence of 0% to 15%. Furthermore, another risk is a retinal detachment, reported from 6% to 8% after ERM surgery. When an unexpected retinal detachment is observed after a surgery, a further surgery is recommended.
A case report of a serous retinal detachment, in absence of a clinically detectable retinal breaks, noticed the day after ERM surgery and with spontaneous resolution. Including OCT-scan imaging and review of the literature.
A 66-year-old male treated with Sintrom, was presented with progressive visual impairment in the right eye. Best- corrected visual acuity (BCVA) was 5/10 in right eye and 7/10 in left eye. Findings from slit lamp of the right eye, revealed a nuclear sclerotic cataract and a mild ERM, confirmed by Optical Coherence Tomography (OCT). As result, a no- combined surgery was considered, so the patient underwent a cataract phacoemulsification under topical anaesthesia, with no adverse events. After 4 months, discarding the presence of ectopic inner foveal layer, he presented with no visual improvement. However, an ERM surgery was performed, by a pars plana vitrectomy under retrobulbar anaesthesia. The peeling of the posterior hyaloid and the internal limiting removal was completed with success. Day one of the postoperatory, a small dome subretinal haemorrhage in the macula, surrounded by a serous retinal detachment was identified. No retinal breaks were identified. Swept source OCT revealed a serous retinal detachment with macular involvement. Because of the findings, observation and not to start Sintrom was decided. 72 hours after improvement was noticeable and at one-month follow-up, fundoscopy and OCT images revealed a completely resolution of the detachment, with a BA improvement.
The presented case is the first report to our knowledge, of a serous retinal detachment, in absence of clinically detectable retinal breaks, noticed the day after ERM surgery and with spontaneous resolution. As shown, on postoperative day 3, the retina was practically plain, with intraretinal fluid noticed in the OCT scan images. However, Akduman. et al, reported four cases of patients who develop a retinal detachment after macular hole surgery, which were resolved spontaneously. The mechanism of formation is unknown, but some hypotheses were proposed. On the one hand, related to small occult retinal tears. These could close when the reabsorption of intraocular gas has stopped in making vitreous traction. The second one, is a supposed temporally postsurgical fluid flow, which could increase though the macular hole. In our case, we could not bear out these facts, because no gas was used and there was no macular hole. Nevertheless, the third hypothesis could explain our case where the iatrogenic stress generated to the retinal tissue in the macula could have developed a retinal detachment. Thereby, we provide more evidence to support that in some cases the detachment is exudative, with no rhegmatogenous origin, considering observation and close follow-up.
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