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Abstract: The patient was diagnosed with a sudden loss of vision in the left eye 7 days ago with no obvious cause, no history of eye redness or eye pain, and was diagnosed locally with retinal detachment in the left eye, which was not treated, and now came to our hospital for further treatment. After communicating with the patient and his family, he underwent surgery. After surgery, the patient’s retina was repositioned, and his vision was restored and he was able to take care of himself.
Basic information】Male, 47 years old
Disease Type】Retinal detachment
Hospital】The First Affiliated Hospital of Zhengzhou University
Time】2021-07
Treatment Plan】General anesthesia surgery (left eye glass removal + complex retinal surgery + laser photocoagulation + silicone oil injection) + nerve-nourishing drugs (rat nerve growth factor)
Treatment Period】4 days of inpatient treatment, 6 months of outpatient follow-up
Treatment effect】Clinical cure, retina reset, patient’s vision restored and self-care achieved
I. Initial consultation
The patient was admitted to the hospital with a complaint of sudden decrease in vision in the left eye for 7 days. 7 days ago, he felt a sudden decrease in vision in the left eye without any obvious cause, and there was no history of eye redness or eye pain. No improvement in self-perception. He was admitted to our department with the diagnosis of old retinal detachment in the left eye, PVR3 in the left eye, and blindness in the right eye for further treatment. Since the onset of the disease, the patient was clear, in good spirits, with normal appetite, normal sleep, normal urination and defecation, and no weight loss. Ophthalmologic examination showed no light perception in the right eye and 0.05 in the left eye; the right eye had a transparent cornea, KP (-), moderate anterior chamber, atrial flash (-), clear iris texture, normal color, round pupil with a diameter of about 3 mm, loss of light reflex, milky clouding of the lens, and poor after-vision; the left eye had a transparent cornea, i.e. (-), moderate anterior chamber, atrial flash (-), clear iris texture, normal color, and a pupil with a diameter of about 5 mm The pupil diameter was about 5 mm, with drug-related dilatation, mild clouding of the lens, mild clouding of the vitreous, clear borders of the fundus optic disc, normal color, gray-white elevation of the retina on the hazel side, fissure below the hazel, peripheral degenerative zone, and subretinal stripe-like proliferation; IOP was 15 mmHg in the right eye and 14 mmHg in the left eye, and the rest (-).
According to the examination results, he was diagnosed with old retinal detachment in the left eye, proliferative vitreoretinopathy in the left eye, and blindness in the right eye.
II. Treatment history
The patient was a one-eyed patient with retinal detachment in the healthy eye resulting in loss of vision and inability to take care of herself. The primary goal of the surgery was to anatomically reposition the retinal detachment, improve the patient’s visual function, and restore the patient’s vision for self-care. After communicating with the patient and his family, the patient underwent surgery. After preoperative examination, there were indications for surgery and no obvious contraindications to surgery, and the patient underwent glass removal in the left eye + complex retinal surgery + laser photocoagulation + silicone oil injection under general anesthesia, and systemic nerve-nourishing drugs such as rat nerve growth factor were administered.
III. Treatment results
Postoperative day 3 ocular examination: no light perception in the right eye, 0.25 in the left eye (corrected); reduced corneal edema in the left eye, KP (-), normal anterior chamber depth, atrial flash (-), cell (-), clear iris texture, normal color, round pupil, about 5mm in diameter, medicated astigmatism, mild clouding of the lens, vitreous silicone oil filling, clear fundus optic disc border, normal color, no reflection of the central macular sulcus. The retina was flattened and the laser spot was visible; the right eye was the same as before surgery; the IOP was checked and was 14 mmHg in the right eye and 17 mmHg in the left eye; the retina was reset and the patient’s vision was restored and he was able to take care of himself. The patient was discharged at 4 days of hospitalization.
Six months after surgery, the right eye was lightless and the left eye 0.7 (corrected); the left eye had a clear cornea, KP (-), anterior chamber (-), clear iris texture, normal color, round pupil, about 5mmn in diameter, drugged astigmatism, mild lens clouding, vitreous silicone oil filling, clear fundus optic disc border, normal color, no macular central concave reflection, flat retina, visible laser spot; the right eye was the same as before surgery. IOP showed 17 mmHg in the right eye and 20 mmHg in the left eye.
IV. Precautions
The very high heart patient’s vision was basically restored after surgical treatment, and he could take care of himself, but it is still recommended that the patient should have regular postoperative review and regular vision testing, which can detect whether there are other lesions in the eye in time. The diet is mainly high protein, high fiber, high vitamin diet, more fresh fruits and vegetables to help the body recover, avoid eating spicy and stimulating food, and avoid smoking and alcohol, keep the bowels smooth, but avoid excessive force to defecate to prevent retinal detachment again. Ensure good sleep quality, combine work and rest, do not spend too much time watching TV and cell phones, and avoid excessive use of eyes. Avoid heavy physical work in the near future and rest in bed more often.
V. Personal insight
The patient’s right eye is blind and the retinal detachment and vision loss in the left eye relative to the healthy eye should be seen in a timely manner, and the changes in visual function should be closely monitored and treated in a timely manner to avoid proliferative vitreoretinopathy in the hope of restoring better visual function. This patient had a long course of disease, untimely treatment, and difficult surgical procedure. Fortunately, the patient’s postoperative visual acuity recovered to 0.7, exceeding our standard for low vision of 0.3 and higher than 0.5, which is clinically considered to have reached the standard for self-care. This plays a great role in improving the quality of life of patients. In addition, retinal detachment should be reviewed in a timely manner to avoid the inability to get timely treatment in case of increased intraocular pressure or recurrent intraocular inflammation.