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Abstract: The patient in this case is an elderly male who presented with blurred vision and obscuration in the right eye 2 days prior to the consultation, so he went to the hospital and was diagnosed with retinal fissure after an outpatient ophthalmologic examination. The patient recovered well after the surgery and was hospitalized for 5 days and then treated with home medication.
Basic information】Male, 67 years old
Disease Type】Retinal fissure
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】March 2022
Treatment plan】Surgical treatment (laser closure) + intravenous injection (glucose injection) + topical medication (atropine sulfate eye drops, heptafolium digitalis bisaccharide eye drops) + oral medication (calcium hydroxybenzene sulfonate capsules, vitamin B1 tablets, methylcobalamin capsules)
Treatment Period】Hospitalization for 5 days, regular review
Effectiveness】The condition was cured and the blurred vision disappeared.
I. Initial consultation
The patient is a 67-year-old male. He complained of blurred vision in his right eye with no obvious cause or trigger two days before the visit. The right eye had a visual acuity of 4.2 and the left eye had a visual acuity of 4.8; both eyes were not congested, the cornea was clear, the anterior chamber was deep, the atrial fluid was clear, the pupil was normal, the lens was cloudy in the center and under the posterior capsule; the right eye had intravitreal blood accumulation, and the fundus examination showed that the right eye had a clear optic disc border, thin arteries and tortuous veins, and a horseshoe-shaped fissure of about 1 PD size was seen in the temporal area with surrounding edema and unclear central reflection. Therefore, the initial diagnosis was retinal fissure in the right eye, and the patient was admitted to the hospital for treatment.
II. Treatment history
After admission, we communicated with the patient and his family and explained that there was no effective drug treatment for retinal fissure, so surgery was recommended to repair the fissure. After discussion, the patient and his family decided to undergo laser closure. The patient was first given calcium hydroxybenzenesulfonate capsules to improve local microcirculation, and glucose injection was given preoperatively to promote the absorption of the surrounding exudate. The patient’s eyes were covered after surgery and the pupils were dilated with atropine sulfate drops to maintain the paralysis of the ciliary muscle. After discharge, the patient was discharged from the hospital and treated at home. After discharge, the patient was discharged with oral vitamin B1 tablets, methylcobalamin capsules, and seven-leaf digitalis double-glucoside drops in both eyes.
III. Treatment effect
After 5 days of hospitalization, although the intravitreal blood still existed, the visual acuity of the right eye had improved from 4.2 to 4.6, and the patient had recovered well after surgery. At the first week of follow-up, the blurred vision in the right eye had disappeared and the blood accumulation had basically subsided, and no abnormalities such as flashing sensation and visual distortion appeared.
IV. Precautions
After laser closure, the patient was instructed to reduce head activities and avoid sneezing, coughing, and straining to defecate to reduce vitreous vibration; at the same time, the right eye should be observed and the medical staff should be notified promptly for treatment when severe flashing sensation occurs. The patient was discharged after 5 days of hospitalization and was very happy. I also felt very relieved to think that the patient’s anxiety and panic due to the disease at the time of admission had faded. The patient and his family were instructed to come to the outpatient clinic for review 1 week after discharge and every 3 months thereafter; to avoid lifting heavy objects in life and to keep the upper body upright as much as possible when picking up things; and to use drugs strictly as prescribed by the doctor for consolidation treatment after surgery.
V. Personal insight
Because the vitreous humor gradually liquefies with age, retinal fissures are more likely to occur in older people like the patient in this case. Fortunately, the patient in this case was treated in time and did not miss the best time for laser repair, and recovered well after surgery.