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Abstract: The patient was diagnosed with retinal detachment in the right eye and fundus hemorrhage in the right eye at the ophthalmology hospital more than half a month ago, and was given blood and eye tablets and compound thromboxane orally without any significant improvement. Now, she came to our hospital for further treatment. Based on her medical history and examination, she was diagnosed with retinal detachment due to retinal fissure and underwent surgery.
Basic information】Female, 12 years old
Type of disease】retinal detachment with retinal fissure in the right eye, old proliferative vitreous lesion in the left eye, and lens-free eye in the left eye
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of Consultation】November, 2020
Treatment plan】Glottopexy of the right eye under general anesthesia + complex retinal repair + laser + silicone oil + medication (brimonidine tartrate drops and mannitol) + laser photocoagulation
Treatment period】7 days of inpatient treatment, 2 weeks of outpatient follow-up
Results】The patient’s vision was restored and there was no other discomfort.
I. Initial consultation
The patient was diagnosed with retinal detachment in the right eye and fundus hemorrhage in the right eye, and was given oral medication such as blood and eye tablets and compound thromboxane, but he felt no significant improvement. The patient was admitted to our department with the diagnosis of retinal detachment in the right eye and old PVR in the left eye. Since the onset of the disease, the patient was clear, had a good spirit, good diet and good sleep. He had normal bowel movements and no significant change in weight.
Visual acuity was 0.1 in the right eye (corrected), no light perception in the left eye; the conjunctiva of the right eye was not congested, the sclera was not yellowish, the middle of the cornea was dotted and cloudy, the remaining transparent, the anterior chamber was moderate, the atrial flicker (-), the iris texture was clear, the color was normal, the pupil was round, about 5mm in diameter, drug dilated, the light reflex was blunt, the lens was mildly cloudy, the vitreous was flocculent, the fundus: the border of the optic disc was unclear, the color was light, the upper and temporal side The retina was highly elevated and a huge fissure was seen above, the conjunctiva of the left eye was not congested, the sclera was not yellowish, the cornea was dotted and cloudy, the anterior chamber was moderate, the atrial flicker (-), the iris texture was clear, the color was normal, the pupil was round, the diameter was about 4 mm, the drug astigmatism, the light reflex was blunted, the lens was absent, the vitreous cavity had a lot of white accretion, and no normal retinal structure was seen in the fundus. OCT: the refractive media of the right eye was unclear, and no macular abnormality was vaguely seen.
The preliminary diagnosis of retinal detachment with retinal fissure in the right eye, old proliferative vitreous lesion in the left eye and lens-free eye in the left eye was made by combining the examination results.
Treatment history
The patient had been blind in the left eye for many years, and the only remaining right eye showed vision loss and loss of learning ability. The primary goal of surgery was to reset the detached retina, repair the retinal fissure, and improve visual function. There were clear indications for surgery and no obvious contraindications to surgery, so the child was given a right eye biosurgery + complex retinal detachment repair + laser + silicone oil filling under general anesthesia, and the cloudy mechanized vitreous and retracted mechanized membrane were carefully removed during surgery to prevent proliferative vitreoretinopathy after surgery.
Considering that the patient had no vision in the left eye, active treatment of the right eye was needed to improve the patient’s quality of life. In addition, the patient’s preoperative IOP was not low and he had a family history of high IOP, so he needed to prevent the development of high IOP after surgery. The patient later developed elevated IOP in the right eye on the 4th postoperative day, and was given brimonidine tartrate drops and mannitol to lower IOP, which was poorly controlled, and was given laser photocoagulation of the ciliary body of the right eye to lower intraocular pressure, and was discharged with an IOP of 26 mmHg in the right eye.
III. Treatment effect
2 weeks after surgery: eye examination: visual acuity: right eye: 0.7 (corrected), left eye: no light perception, mild conjunctival congestion in the right eye, no yellowing of the sclera, punctate clouding and mild edema of the corneal endothelium, moderate anterior chamber, atrial flash (-), clear iris texture, normal color, round pupil, about 3 mm in diameter, light reflection, mild lens clouding, vitreous cavity filled with silicone oil, fundus: clear optic disc border, light color, fundus leopard pattern. pale color, fundus leopard-like changes, posterior pole retinal flattening, scattered laser spots visible in the superior temporal, nasal and peripheral areas, central macular concave reflection not seen; left eye conjunctiva not congested, sclera not yellowish, corneal endothelium visible dotted clouding, residual transparency, anterior chamber moderate, atrial flash (-), iris texture clear, normal color, pupil round, diameter about 4mm, drugged scatter, blunted light reflex, lens absent, vitreous cavity A large amount of white proliferation, fundus: no normal retinal structures were seen. IOP: 18 mmHg in the right eye and 11 mmHg in the left eye. examination showed that the patient’s visual acuity was significantly restored and there was no other discomfort.
IV. Precautions
After treatment, the patient’s visual acuity recovered significantly, for which he felt particularly relieved, but it is recommended that the patient still needs to pay attention to the following matters after discharge from the hospital.
1, to closely monitor the level of intraocular pressure and the health of the ocular surface, and to promptly follow up if they feel elevated intraocular pressure or damage to the cornea.
2. The silicone oil filled in the eye after surgery will change the refractive state, and temporary myopia reduction or farsightedness aggravation will occur. Consider replacing glasses in the short term in order to return to school this morning.
3. It is recommended to adopt a head-low sitting position after surgery, keeping the fissure in the highest position and avoiding supine position to prevent lens clouding and complications such as secondary glaucoma.
4. It is also recommended that the patient avoid strenuous exercise for six months after discharge from the hospital to avoid affecting the recovery of the disease.
V. Personal insight
1, the patient’s left eye blindness, relative to the healthy side of the eye – right eye vision loss should be promptly consulted, pay close attention to the changes in visual function, timely treatment, and desire a better recovery of visual function.
2. If the patient’s close relatives have similar diseases, they should be considered as hereditary or genetic diseases. Patients with a family history are advised to visit an outpatient ophthalmology clinic for screening and early detection and treatment.
3. School-age and adolescents are in a period of intense learning and have high requirements for visual function, and if patients lose their vision during school age, the quality of life may be seriously affected. Therefore, children with low vision should be actively treated at the hospital this morning, as in the case of the child in question, whose vision has been significantly restored through certain treatments.