Laurence Lim, Singapore

Non-rhegmatogenous retinal detachments include cases due to haemorrhagic and exudative causes. These management of these cases is challenging as the detachments are usually extensive and the prognosis extremely guarded, and a combined medical and surgical approach is usually needed. There is also often a pressing need to treat these cases expediently due to the sight and globe threatening nature of these conditions. The aim of this study is to describe the indications and surgical approaches to the management of non-rhegmatogenous retinal detachment.

This study included 10 cases with non-rhegmatogenous retinal detachment. The underlying pathology included massive subretinal haemorrhage due to polypoidal choroidal vasculopathy (PCV) in 5 cases, Coats disease in 3 cases, as well as chronic multifocal central serous retinopathy (CSR) in 2 cases.

Surgical approaches included vitrectomy with external drainage of blood or fluid in 7 cases, vitrectomy with internal drainage in 2 cases, and combined internal/external drainage in 1 case. Adjunctive surgical manoeuvres included lensectomy in 9 cases, and scleral buckling in 2 cases. Silicone oil tamponade was applied in all cases. Medical adjuncts used included intravitreal anti-VEGF agents in 8 cases, and photodynamic therapy in 2 cases. The pre-operative vision was poor in all cases, ranging from light perception to counting fingers. Post-operatively, retinal reattachment was achieved in all cases, with categorical improvement in vision although the median visual acuity remained poor at counting fingers. No cases progressed to phthisis bulbi. Surgical videos will be presented to highlight the key surgical strategies.

Complex non-rhegmatogenous retinal detachments can be successfully managed with a carefully planned combined medical and surgical approach. In most cases, external drainage that avoids creating a retinal defect is preferable. Anatomical success with retinal reattachment and globe preservation can be achieved, although the prognosis for vision is usually very guarded. Patients with these challenging conditions need careful counselling on the realistic goals of surgery for globe preservation as vision recovery is usually limited.

Contact Details:
Laurence Lim
Singapore National Eye Centre
Cell Phone : 98261974
Work Phone : 98261974
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