Introduction:

Any surgical pathology presenting with concomitant inflammation presents a dilemma to the eye surgeon, due to the increased risk of post-op complications. On the other hand, a retinal detachment presents an additional challenge to the vitreoretinal specialist in this situation. The authors present a clinical case with both these simultaneous conditions.

Case Report:

We present the case of a male 75 year-old patient, with a panuveitis, a secondary cataract with posterior synechiae, as well as a macula-off retinal detachment of an unknown duration. Due to the extensive inflammation and synechiae, a full retinal examination was impossible and we could not search for peripheral retinal tears. We decided first to treat the panuveitis with oral prednisolone 1mg/kg/day and wait for the inflammation to be controlled. After 1 week, the patient was submitted to a combined phacoemulsification, with the aid of a Malyugin ring, and 23-gauge vitrectomy. Intraoperatively, we observed a macular hole and a superior peripheral retinal tear. We therefore chose to perform an ILM peeling under PFC liquid, performed endolaser to treat the peripheral tear and tamponated the eye with C3F8. Conclusions: significant inflammation may accompany any surgical pathology, prompting a careful evaluation and treatment before rushing into the operating room. Also, macular hole-associated retinal detachments suggest the need for an ILM peel during the vitrectomy, although the primary cause of the RD is usually found to be a peripheral tear.

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