Advantages:

To report a clinical case of long-standing post-operative high best corrected visual acuity (BCVA) after scleral buckling procedure due to rhegmatogenous retinal detachment (RD) with incomplete macular reattachment.

Methods:

A sixty-four-year-old female was admitted to Kyiv Eye Microsurgery Center in September 2011 with diagnosis of rhegmatogenous RD (extension from 5 to 11 o’clock) on her right eye temporal side with macula-off. Lens with cortical peripheral opacities. Peripheral small horseshoe brake surrounded with lattice degeneration (from 8 to 10.30 o’clock) was discovered at 9 o’clock with scleral depression. Pre-op BCVA was hand movement. Next day patient underwent scleral buckling with 3×5 concentric sponge from 8 to 11 o’clock with subretinal fluid drainage and cryo. Post-op: BCVA was 0.4 with restored visual fields, retina was completely reattached and retinal brake blocked. In 1 month patient presented with complains on slight blurred central vision. After examination BCVA was 0.7 and visual field defects were observed. On OCT scans incomplete reattachment of the macula extending toward 6 o’clock was revealed. The height of subretinal space had reached 200 micron and foveal contour was prominent. Patient was observed during next two weeks with Diamox prescribed and then the situation was the same, repeated surgery was offered to her from which she refused. Patient was followed-up every month within 6 months. BCVA remained stable 0.7 with slight blurring of central vision. OCT scan still showed incomplete macular reattachment with little thinning of detached retinal layers.

Effectiveness / Safety:

According to clinical data of the reported case there has to be certain but precise interaction between retinal pigment epithelium and detached photoreceptor layer through subretinal fluid which maintains high visual acuity.

Take home message:

Human compensatory mechanisms of retinal layers can ensure high central visual acuity even being detached. Such an unexplained characteristics of retinal function has to be discovered properly.