SCIENTIFIC POSTER_Miriam Garcia Fernandez_2

Advantages:

To report the anatomical and functional evolution in a case of persistent subretinal fluid after vitrectomy and scleral buckling for longstanding retinal detachment. We emphasize the value of the OCT to monitor the resolution of subretinal fluid.

Methods:

A 37-year-old male presented with visual loss in the left eye (LE) of more than four months duration. A complete ocular examination including visual acuity testing (VA), anterior and posterior biomicroscopy and optical coherence tomography (OCT) were performed.

Effectiveness/safety:

At first visit, clinical examination revealed that visual acuity was 0.3 (decimal scale) in his LE and 1.0 in his RE. Fundus examination showed an inferior chronic rhegmatogenous retinal detachment sparing the fovea that was caused by a large horseshoe tear located in the infratemporal quadrant. The patient underwent uneventful 20-gauge pars plana vitrectomy with fluid-air exchange, sulfur hexafluoride (SF6) 15% gas tamponade and laser. Four weeks postoperatively when the gas had completely resolved, VA was 0.8. On fundus examination, the retina was flat, but OCT showed shallow subretinal fluid sequestered between the retinal pigment epithelium and neurosensory layer. Three months postoperatively, VA has remained stable, and OCT showed persistent subretinal fluid. Seven months after vitrectomy, OCT still detected subretinal fluid, but less. At last examination (one year after surgery), VA continues to remain stable, and OCT demonstrated complete resolution of the subretinal fluid.

Conclusions:

Subretinal fluid may persist after surgery in chronic rhegmatogenous retinal detachment, even though the retina may appear fully attached by ophthalmoscopy. Persistent subretinal fluid may delay visual recovery, causing poor VA, metamorphopsia and loss of spacial vision. The effect on the final outcome remains unclear, possibly promoting irreversible retinal/pigment epithelium changes. Pathophysiology of persistent subretinal fluid after successful surgery is poorly understood. In longstanding detachments, the higher colloid osmotic pressure of subretinal fluid remnants may act against fluid absorption. Therefore, continuous follow-up including OCT examination is useful to monitor these cases.