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Abstract
1
Case report
A 9-year-old boy was referred to our service for the first time for an emergency consultation
with worsening vision in his right eye for 2 days. He had a pencil injury to the right
eye seven months prior with a ruptured globe repair and subsequent posterior chamber
intraocular lens (PCIOL) surgery for a traumatic cataract six months after the injury;
this repair was performed by another provider. Visual acuity of the right eye at initial
presentation was count fingers.
2
Discussion
Clinical examination showed what appeared to be a giant retinal tear, but during surgical
repair we found a huge giant tear with 180-degree macula-off retinal detachment and
temporal retinal dialysis from 6 to 12 o'clock. There was no PVD. A B-scan was not
performed because the view was clear enough to see the retinal detachment. Surgical
repair involved 23-gauge pars plana vitrectomy with perfluorocarbon placement, triamcinolone
(Kenalog) injection, membrane peeling, endolaser, air fluid exchange, inferior iridotomy,
and silicone oil placement. We considered scleral buckle but felt the vitrectomy would
be effective in repairing the retinal detachment. We felt the vitrectomy could effectively
relieve the tractional forces without the need for a buckle. Two days following surgical
repair, visual acuity improved to 20/300 and two weeks post surgery was 20/150 without
correction. (see Fig. 1).
Fig. 1
A, Image taken during clinical examination showing what appeared to be a giant retinal
tear; B, Complex macula-off retinal detachment with 180° of temporal retinal dialysis
from 6 to 12 o'clock found intra-operatively; C, Two days postoperative attachment
of the retina under silicone oil and laser.
Fig. 1
3
Conclusion
Although a majority of retinal tears and retinal dialysis typically occur within 1
month following globe rupture, this case demonstrates that retinal dialysis is possible
for an extended time following injury, especially in pediatric patients.1, 2 Close
monitoring is essential for early detection, and timely surgical repair of retinal
injury may help to preserve vision especially if performed before involvement of the
macula.
Funding
No funding or grant support.
Conflicts of interest
The authors have no financial disclosures.
Dr. Do is a member of the editorial board of American Journal of Ophthalmology Case
Reports. She had no involvement in the peer-review of this article and has no access
to information regarding its peer review.
The following authors have nothing to disclose: AD, WR, and AB.
Authorship
All authors attest that they meet the current ICMJE criteria for Authorship.