OOMC News

CC: 68 yo woman was referred to us for a cataract in her right eye. The patient reported ipsilateral decreased vision in the right eye only for about 1 month.  She reported she had been in a car accident about 5 months ago. It was a head-on collision in which air-bags were deployed. She denied photopsias, but reported some floaters in that eye. She reports central darkening of the vision.

PMHX: none

Past ocular history: no surgical history, no history of glaucoma.

BCVA: CF OD, 20/20 OS

IOP: 18 OD, 21 OS

SLE:

Conjunctiva/sclera: white and quiet OU

Cornea: clear ou

Iris- wnl ou, no rubeosis

2+ combined NS/PSC cataract OD

1+ NS cataract OS

Gonioscopy – no angle recession ou

DFE: see imaging below

Imaging:

Widefield color fundus photo of the right eye showed a macular retinal detachment due to a large eccentric macular hole with significant overlying epiretinal membrane.

Here is a closer look at the macula of the right eye.

Widefield photo of the left eye. DFE of the left eye was unremarkable.

SD-OCT through the macula of the right eye clearly shows the large macular hole with retinal detachment.

OCT of the left macula shows a partial PVD but is otherwise unremarkable.

Bscan of the right eye confirms the macular detachment.

Assessment:

68 year-old woman with a visually significant cataract right eye and macular detachment right eye due to large open eccentric macular hole with overlying epiretinal membrane. Suspect macular hole and cataract formation were traumatic.

Plan:

• Work together with anterior segment team, and plan cataract extraction right eye ASAP to be followed by surgical repair of the retinal detachment with pars plana vitrectomy (PPV), peeling of the overlying epiretinal membrane, air-fluid exchange and injection of a long acting gas.
• Plan for the patient to position face down following the surgery for several days.
• Plan to close the hole with intraoperative laser, as the hole was traumatic, large and unlikely to close without laser, with high risk of redetachment of the retina without laser.
• Guarded visual prognosis

Follow-up:

The patient underwent successful cataract extraction with IOL placement a few days later, then had her retinal surgery with gas injection. Post-operatively,  the gas bubble dissolved and the macula reattached nicely. As planned, the macular hole remains open but the retina is reattached.

Post-operatively the vision improved to 20/200. The patient will have continued follow up care with the retina team.

Post-operative SD-OCT showing edges of the macular hole are now flat. The epiretinal membrane is gone. There is evidence of trace subretinal fluid temporal to the hole that will resolve as the hole is now closed and there are no open breaks in the retina.