University of Iowa Health Care

Ophthalmology and Visual Sciences

EyeRounds.org

Rhegmatogenous Retinal Detachment, Macula-Off

Contributor: Eric Chin, MD

Photographer: Cindy Montague, CRA

Patient

  • A 62 year old female with a history of uncomplicated cataract surgery in both eyes, presented to the comprehensive clinic for decreased vision in the left eye since one day prior. She said her nasal field of vision had become abruptly and increasingly blurry while doing the laundry. She denied any flashes, floaters, or other complaints. She denied prior trauma or recent falls. She had no family history of retinal detachments.
  • Vision: OD 20/25-3; OS 20/100+1
  • IOP: 14 and 13
  • Manifest refraction prior to cataract surgery:
    • OD: -13.25 +0.75 045
    • OS: -9.25 +0.50 040
    • Slit lamp exam: Posterior chamber intraocular lenses and posterior capsular opacities, both eyes

scattered areas of lattice degeneration near the ora

Image 1: OD: clear media; normal disc, vessels and macula; in the periphery, there were scattered areas of lattice degeneration (270 degrees from 4 to 1 o'clock clockwise) near the ora, however there were no other retinal tears or detachments. (click image for higher resolution)

OCT

Image 2: OD OCT: normal (click image for higher resolution)


scattered areas of lattice degeneration near the ora

Image 3: OS: low magnification montage, rhegmatogenous macula-off retinal detachment (temporal to the white arrows); not shown, the patient had a horseshoe retinal tear at 1 o'clock near the ora, as well as multiple areas of lattice degeneration near the ora from 10 to 2 o'clock and 4 to 8 o'clock clockwise. Intraoperatively, there were multiple holes seen in her lattice degeneration at 5 o'clock and 6:30 o'clock. (click image for higher resolution)


scattered areas of lattice degeneration near the ora

Image 4: OD: higher magnification of the rhegmatogenous retinal detachment that involves the macula. (click image for higher resolution)


OCT

Image 5: OCT OS: limited quality, macula-off retinal detachment without a macular hole.(click image for higher resolution)


  • The patient underwent a scleral buckle, 25-gauge pars plana vitrectomy, laser indirect ophthalmoscopy, air-fluid exchange, and injection of 22% SF6, in the left eye.
  • The right eye was also treated with prophylactic laser indirect ophthalmoscopy intraoperatively.

Risk Factors for Retinal Detachments

  • Age*
  • High myopia*
  • Co-morbid eye conditions, such as lattice degeneration*
  • Prior eye surgery*
  • Prior retinal detachment
  • Family history of retinal detachment
  • Trauma

*Risk factors seen in our patient are highlighted in bold.


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Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

last updated: 9/13/2013
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