Persistent serous retinal detachment after radial optic neurotomy

Risk factors for failure of resolving optic disc pit maculopathy after primary vitrectomy without laser photocoagulation

PURPOSE

To determine factors significantly correlated with the failure of macular reattachment by pars plana vitrectomy (PPV) without laser photocoagulation of the optic disc margin to treat optic disc pit (ODP) maculopathy.

DESIGN

Retrospective, interventional case series.

METHODS

We reviewed the medical records of 35 consecutive patients with ODP maculopathy who underwent PPV without laser photocoagulation. PPV with the creation of a posterior vitreous detachment (PVD) was performed in 34 eyes. An epiretinal membrane and internal limiting membrane present in the other eye with a PVD were removed. Patients were followed for 12-193 months (mean 58 months) after surgery. The main outcome measures were the postoperative rate of retinal reattachment and best-corrected visual acuity. The preoperative clinical characteristics of the successful cases were compared to those of the unsuccessful cases.

RESULTS

A complete retinal reattachment was attained in 31 of 35 eyes and it required about one year. The 4 other eyes that did not achieve a macular reattachment after the primary PPV underwent additional therapies. The factors that were significantly associated with a failure of a retinal reattachment after primary PPV were the presence of a retinal detachment connected to the optic disc (P < 0.001) and the presence of preoperative headaches (P = 0.030).

CONCLUSIONS

Clinicians should be aware that the presence of a preoperative macular detachment connected to the optic disc margin and preoperative headaches are indicators for an unsuccessful outcome of PPV without laser photocoagulation in eyes with ODP maculopathy.

[Circumscribed retinal detachment after radial optic neurotomy for central retinal vein occlusion]

OBJECTIVE

It has been suggested that radial optic neurotomy (RON) may improve the functional outcome of retinal vein occlusions. We report the case of a patient presenting with a high, but circumscribed, peripapillary retinal detachment following RON for central retinal vein occlusion.

RESULTS

A 69-year-old man presented with a high retinal detachment 2.5 years after RON for central retinal vein occlusion. It was complicated by a recurring cystoid macular edema; however, best visual acuity was 0.5. The retinal detachment developed slowly. Its location was nasal and superior to the optic disc. It did not extend beyond the equator and had no detectable retinal break. The retinal detachment was successfully treated by an encircling band, pars plana vitrectomy, laser coagulation, and air endotamponade. There was no obvious persisting retinal defect at the RON site.

CONCLUSIONS

Although other mechanisms should be taken into account, this case indicates that it might be possible to create a fistula between the subarachnoid and subretinal space, leading to a slowly developing retinal detachment. A similar case report pointed out that special attention should be paid to the depth of the radial incision into the optic nerve head.