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Abstract: This is a case of a 67-year-old female patient who presented to the clinic with an obscured external lower visual field in her right eye that gradually expanded and had black shadows floating in front of her eyes after holding her grandson on the stairs and holding her breath. After a series of outpatient examinations, the patient was diagnosed with foraminogenic retinal detachment in the right eye. After scleral pressure + condensation + laser photocoagulation in the right eye and postoperative medication, the patient’s black shadows disappeared and the visual field was no longer defective.
Basic information】Female, 67 years old
Disease Type】Pore-derived retinal detachment in the right eye
Hospital】Shanghai Changhai Hospital
Date of Consultation】February 2022
Treatment plan】Surgical treatment (right eye extra-scleral pressure + condensation + laser photocoagulation)
Treatment Period】4 days of hospitalization, 1 month of outpatient review
Effectiveness】Good postoperative recovery, disappearance of black shadows in front of the eyes
I. Initial consultation
The patient, a retired worker, came to the clinic after holding her grandson’s breath while walking up the stairs, and developed a blocked visual field in the lower part of her right eye, which gradually enlarged, with black shadows floating in front of her eyes. After slit lamp examination, he was given an ocular ultrasound, which showed retinal detachment in the right eye and no abnormality in fundus photography (because fundus photography is a 50-degree range, this patient’s retinal detachment was not photographed in the periphery). After pupil dilation, a 2PD horseshoe-shaped fissure was seen in the right eye, and a greenish-gray elevation of the retina was seen at 12:00-4:00 with tortuous blood vessels, which did not involve the macula.
The patient was told that if he did not receive timely treatment, the scope of retinal detachment would become larger and larger, and the postoperative effect would be affected, and it would be difficult to restore vision. Since the patient had a right foramen-derived retinal detachment and it was above, there was also obvious traction around the fissure, as well as a horseshoe-shaped hole cover, so the surgical method of extra-scleral pressure could be chosen, but there was a certain risk that the scope of detachment might be detached, resulting in incomplete retinal apposition, and if vitrectomy combined with retinal detachment repositioning was chosen, it might be necessary to implant silicone oil and the possibility of secondary surgery. After communication, the patient and family agreed to the surgical treatment.
II. Treatment history
The patient was then coordinated with an emergency bed, admitted to the hospital, and both eyes were bandaged and the right lateral recumbent position was chosen. The patient’s cervical spine may not be able to withstand it. While settling on the surgical plan, the patient was given a blood draw, electrocardiogram, and chest X-ray in accordance with the preoperative preparation. After 24 hours of bilateral eye bandaging, the retinal bulge was found to be highly reduced after dilating the pupil on the 2nd day, and the patient reported the location of the visual field occlusion, and the vision was better than before, and the patient’s emotions were relieved for a moment. On the 2nd day after admission, the patient underwent extra-scleral pressure + condensation + laser photocoagulation on the right eye under local anesthesia, and the procedure went smoothly.
III. Treatment results
On the 1st day after surgery, the patient’s gauze was opened and the patient reported that the dark shadows disappeared and the visual fields seen were full and no longer defective. the patient finally showed a smile and checked that the visual acuity of the right eye had recovered to 0.6. after pupil dilation, it was found through anterior microscopy that the patient’s pressure ridge was elevated and the retinal fissure was visible on the anterior slope of the pressure ridge. intraocular pressure: 16 mmHg in the right eye. the patient was instructed to continue bed rest and avoid strenuous activities. The patient was given glucocorticoid drops for anti-inflammation and dilating drops for pupil movement after surgery, and was instructed to measure IOP daily.
IV. Notes
We are glad that the patient recovered from the surgery, but we suggest that the patient should be reviewed regularly at 1 week, 2 weeks, 1 month, and 3 months after discharge from the hospital at the outpatient clinic, mainly reviewing ocular ultrasound, intraocular pressure, fundus photography, visual acuity, and focusing on checking whether the retinal fissure is attached and reset.
Patients are advised to avoid carrying heavy objects or lifting heavy objects, doing heavy physical work, holding breath, and overexertion for 1 month after discharge from the hospital. At home, you can test whether the visual field of the affected eye is full by covering the healthy eye to initially determine whether it is recurrent.
V. Personal insight
The incidence of retinal detachment is increasing year by year with the increase of myopic population and the use of electronic products in China. Retinal detachment is difficult to detect, and if it is not treated in time, or if the retinal detachment is long, it will cause retinal cone and rod cell apoptosis, and even if the retina is reset after surgery, the vision will not recover well.
This patient was found in time and the retinal detachment had not yet involved the macula when he was seen in the outpatient clinic, and the patient recovered his visual function through surgery in the shortest time possible. If the retinal detachment involves the macular area, it will lead to poor recovery of vision after surgery. Therefore, if you find eye discomfort, you must seek medical examination and active treatment as soon as possible.