February 12, 2021
Authored by Burton Wisotsky, MD
A 13 year old girl was referred for vision loss in her right eye. She noted reduced vision one month ago with has slowly worsened. She reports no past medical history, ocular history, amblyopia, or trauma. She is not myopic. On examination, VA was OD: 20/400 and OS: 20/20. IOP’s were OD: 11 and OS: 15. The SLE was unremarkable. There was a 1+ RAPD OD. Bscan and DFE are noted below:
The patient was noted to have a 2.5 clock hour inferotemporal retinal dialysis with quadrantic retinal detachment with the macula off. The subretinal fluid was just in the macula. The first issue is why a nonmyopic healthy 13 year old would have a retinal dialysis and detachment, and the second issue is how to treat it. Regarding etiology, most patients with a retinal dialysis (disinsertion of the retina from the vitreous base) have had previous ocular or head trauma. Our patient denied all trauma. Another cause of childhood retinal detachment is high myopia. Our patient was an emmetrope. There can also be familial retinal detachment due to vitreoretinal degenerations such as Stickler’s syndrome. There was no family history of retinal detachment. Our patient probably had a previous traumatic incident that either she didn’t remember or would not acknowledge.
Treatment options for retinal detachment include laser, scleral buckle, pneumatic retinopexy and vitrectomy. Most young patients do best with scleral buckle because it is difficult to relieve traction in a young patient with vitrectomy. In our case however, the tear was so large that traditional scleral buckling would be difficult. The procedure chosen was a scleral buckle with a large silicone element. Instead of placing the standard 5.5mm buckle around the eye, the standard buckle was placed in tandem with an additional 4mm round sponge for extra buckling effect and support. In addition a small gas bubble was inserted to push the retina back to its native position. Two days after surgery and left side down positioning, the retina was reattached (see below). Vision is still only 20/200 but should gradually improve over the next several months. While it is unlikely for the vision to return to 20/20, with a myopic correction the vision could approach that level.
*Addendum – Vision 10 months after surgery with a -2.00 correction OD was 20/40.