GIANT PIGMENT EPITHELIAL TEAR AFTER SCLERAL BUCKLING FOR RHEGMATOGENOUS RETINAL DETACHMENT Kana Tsuda, MD,* Shuichi Yamamoto, MD, PHD,* Michitaka Sugahara, MD,† Takeshi Sugawara, MD, PHD,* Yoshinori Mitamura, MD, PHD*
Purpose: To describe a patient with rhegmatogenous retinal detachment (RRD) who developed a giant tear of retinal pigment epithelium (RPE) after scleral buckling. Patient: A 64-year-old man with RRD underwent scleral buckling and cryoretinopexy on his right eye. Results: A #506 silicone sponge was placed on the exit of the three vortex vein to seal retinal tears. On the 3rd postoperative day, a choroidal detachment appeared, and on the 10th postoperative day, a large RPE developed at the posterior edge of the choroidal detachment. One month later, the entire retina was completely attached without any treatment. Conclusions: Ophthalmic surgeons should be aware that an RPE tear can be associated with choroidal detachment after scleral buckling. RETINAL CASES & BRIEF REPORTS 2:115–116, 2008
From the *Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, and the †Department of Ophthalmology, Toho University Sakura Hospital, Sakura, Japan.
Case Report A 64-year-old Japanese man was referred to the Eye Clinic of Toho University Sakura Hospital (Sakura, Japan). Ophthalmoscopy showed a localized retinal detachment in the lower peripheral quadrant of the right eye that was associated with horseshoe retinal tears at 5 o’clock and 7 o’clock. He underwent cryoretinopexy and scleral buckling with a number 506 silicone sponge. The silicone sponge was placed on the exit of the three vortex veins to seal the retinal tears. The subretinal fluid was not drained, but the extent of the subretinal fluid was markedly decreased on the next day. On the third postoperative day, a choroidal detachment appeared in the lower periphery with an increase in the extent of the subretinal fluid, and the choroidal detachment extended to the superotemporal periphery. On the 10th postoperative day, a large RPE tear developed at the posterior edge of the choroidal detachment, and the extent of the subretinal fluid increased markedly (Fig. 1A). Fluorescein angiography showed a large area of marked hyperfluorescence corresponding to the large RPE tear (Fig. 1B). The patient was observed without any treatment, and 1 month later, the entire retina was completely reattached with a large area of RPE atrophy corresponding to the RPE tear (Fig. 1C). One year after surgery, visual acuity in the right eye was 20/20, and no recurrence of retinal detachment or RPE tear was observed.
T
he development of tears in the retinal pigment epithelium (RPE) has been reported to occur mainly in eyes with age-related macular degeneration.1 However, RPE tears have developed after glaucoma surgery2 and in association with retinal detachments.3 A MEDLINE search of the literature did not extract any articles reporting the development of an RPE tear after scleral buckling. We describe a patient who had a giant RPE tear and exudative retinal detachment after scleral buckling for a rhegmatogenous retinal detachment.
Reprint requests: Shuichi Yamamoto, MD, PhD, Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; e-mail: [email protected]
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Discussion A giant tear of the RPE developed in our patient after enlargement of the choroidal detachment following scleral buckling. We suggest that the choroidal detachment was probably caused by a posteriorly placed scleral buckle compressing the vortex veins. The choroidal detachment itself may have stretched the RPE, resulting in the RPE tear. RPE tears have been reported after filtering surgeries for glaucoma,2 resulting from choroidal detachments caused by postoperative hypotony. After scleral buckling, a choroidal detachment is relatively common, and the primary pathogenic factor for the development of choroidal detachment is vortex vein obstruction.4,5 The natural course of choroidal detachment is generally benign if its extent is moderate and not affecting retinal apposition. In our case, the presence of a predisposing pigment epithelial detachment cannot be excluded; however, ophthalmic surgeons should be aware that an RPE tear can be associated with choroidal detachment after scleral buckling especially when the buckling material is placed over the vortex veins. Key words: choroidal detachment, retinal pigment epithelium tear, scleral buckling, vortex vein.
References 1. 2.
3.
4. 5.
Fig. 1. Fundus photographs and fluorescein angiogram of a patient with a rhegmatogenous retinal detachment. A, Composite fundus photograph showing the large retinal pigment epithelium (RPE) tear and retinal detachment (arrowheads). B, Fluorescein angiogram showing a sharply demarcated area of hyperfluorescence corresponding to the exposed Bruch membrane and choroid. The retracted RPE appears hypofluorescent (arrows). C, Composite fundus photograph 3 months after surgery showing complete reattachment of the retina.
Hoskin A, Bird A, Sehmi K. Tears of the detached retinal pigment epithelium. Br J Ophthalmol 1981;65:417–422. Laatikainen L, Syrdalen P. Tearing of retinal pigment epithelium after glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 1987;225:308–310. Swanson DE, Kalina RE, Guzak SV. Tears of the retinal pigment epithelium: occurrence in retinal detachments and a choroidal scar. Retina 1984;4:115–118. Hayreh SS, Baines JAB. Occlusion of the vortex veins: an experimental study. Br J Ophthalmol 1973;57:217–238. Aaberg TM. Experimental choroidal detachments. Mod Probl Ophthalmol 1974;12:167–172.
Purpose: To describe a patient with rhegmatogenous retinal detachment (RRD) who developed a giant tear of retinal pigment epithelium (RPE) after scleral buckling. Patient: A 64-year-old man with RRD underwent scleral buckling and cryoretinopexy on his right eye. Results: A #506 silicone sponge was placed on the exit of the three vortex vein to seal retinal tears. On the 3rd postoperative day, a choroidal detachment appeared, and on the 10th postoperative day, a large RPE developed at the posterior edge of the choroidal detachment. One month later, the entire retina was completely attached without any treatment. Conclusions: Ophthalmic surgeons should be aware that an RPE tear can be associated with choroidal detachment after scleral buckling. RETINAL CASES & BRIEF REPORTS 2:115–116, 2008
From the *Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, and the †Department of Ophthalmology, Toho University Sakura Hospital, Sakura, Japan.
Case Report A 64-year-old Japanese man was referred to the Eye Clinic of Toho University Sakura Hospital (Sakura, Japan). Ophthalmoscopy showed a localized retinal detachment in the lower peripheral quadrant of the right eye that was associated with horseshoe retinal tears at 5 o’clock and 7 o’clock. He underwent cryoretinopexy and scleral buckling with a number 506 silicone sponge. The silicone sponge was placed on the exit of the three vortex veins to seal the retinal tears. The subretinal fluid was not drained, but the extent of the subretinal fluid was markedly decreased on the next day. On the third postoperative day, a choroidal detachment appeared in the lower periphery with an increase in the extent of the subretinal fluid, and the choroidal detachment extended to the superotemporal periphery. On the 10th postoperative day, a large RPE tear developed at the posterior edge of the choroidal detachment, and the extent of the subretinal fluid increased markedly (Fig. 1A). Fluorescein angiography showed a large area of marked hyperfluorescence corresponding to the large RPE tear (Fig. 1B). The patient was observed without any treatment, and 1 month later, the entire retina was completely reattached with a large area of RPE atrophy corresponding to the RPE tear (Fig. 1C). One year after surgery, visual acuity in the right eye was 20/20, and no recurrence of retinal detachment or RPE tear was observed.
T
he development of tears in the retinal pigment epithelium (RPE) has been reported to occur mainly in eyes with age-related macular degeneration.1 However, RPE tears have developed after glaucoma surgery2 and in association with retinal detachments.3 A MEDLINE search of the literature did not extract any articles reporting the development of an RPE tear after scleral buckling. We describe a patient who had a giant RPE tear and exudative retinal detachment after scleral buckling for a rhegmatogenous retinal detachment.
Reprint requests: Shuichi Yamamoto, MD, PhD, Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; e-mail: [email protected]
115
116
RETINAL CASES & BRIEF REPORTSℜ
●
2008
●
VOLUME 2
●
NUMBER 2
Discussion A giant tear of the RPE developed in our patient after enlargement of the choroidal detachment following scleral buckling. We suggest that the choroidal detachment was probably caused by a posteriorly placed scleral buckle compressing the vortex veins. The choroidal detachment itself may have stretched the RPE, resulting in the RPE tear. RPE tears have been reported after filtering surgeries for glaucoma,2 resulting from choroidal detachments caused by postoperative hypotony. After scleral buckling, a choroidal detachment is relatively common, and the primary pathogenic factor for the development of choroidal detachment is vortex vein obstruction.4,5 The natural course of choroidal detachment is generally benign if its extent is moderate and not affecting retinal apposition. In our case, the presence of a predisposing pigment epithelial detachment cannot be excluded; however, ophthalmic surgeons should be aware that an RPE tear can be associated with choroidal detachment after scleral buckling especially when the buckling material is placed over the vortex veins. Key words: choroidal detachment, retinal pigment epithelium tear, scleral buckling, vortex vein.
References 1. 2.
3.
4. 5.
Fig. 1. Fundus photographs and fluorescein angiogram of a patient with a rhegmatogenous retinal detachment. A, Composite fundus photograph showing the large retinal pigment epithelium (RPE) tear and retinal detachment (arrowheads). B, Fluorescein angiogram showing a sharply demarcated area of hyperfluorescence corresponding to the exposed Bruch membrane and choroid. The retracted RPE appears hypofluorescent (arrows). C, Composite fundus photograph 3 months after surgery showing complete reattachment of the retina.
Hoskin A, Bird A, Sehmi K. Tears of the detached retinal pigment epithelium. Br J Ophthalmol 1981;65:417–422. Laatikainen L, Syrdalen P. Tearing of retinal pigment epithelium after glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 1987;225:308–310. Swanson DE, Kalina RE, Guzak SV. Tears of the retinal pigment epithelium: occurrence in retinal detachments and a choroidal scar. Retina 1984;4:115–118. Hayreh SS, Baines JAB. Occlusion of the vortex veins: an experimental study. Br J Ophthalmol 1973;57:217–238. Aaberg TM. Experimental choroidal detachments. Mod Probl Ophthalmol 1974;12:167–172.
