17th evrs meeting · macular buckle for retinal detachment with macular hole – case report 17th...
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MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT
17th EVRSMEETING
LuísaMalheiro1,BernardetePessoa1,JoãoMeloBeirão1,AngelinaMeireles1
1 Ophthalmological Department - CentroHospitalarUniversitáriodoPorto,Portugal
MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT
INTRODUCTION: Macular buckling is a surgical technique used for retinal detachments dueto macular hole in high myopic patients. The purpose of the macular buckle is to counteractthe pulling effect of the posterior staphyloma.
MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT
CLINICALHISTORY:
- 65years-old female patient.
- High myopic.
- Loss of visualacuity inthe right eyewith twomonths of evolution.
- Nohistory of traumaor previousophthalmological surgeries.
OPHTHALMOLOGICALEVALUATION:
- BCVA:ORhandmovements,OS 20/200with spectacles
- Biomicroscopy:bilateralcataracts,depth anteriorchamber
- IOP:14/30mmHg
- Fundoscopy:bilateralmyopic coroidosis,posteriorpolestaphyloma,retinal detachment associated with amacularhole inthe OR
- Axiallength:OR 30,86mm,OS 30,72mm
MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT
ThepatientwassubmittedtoacombinedPHACOVITRECTOMY intherighteye:
Epirretinal peeling +invertedinternallimitingmembraneflaptechniqueformacularhole+peripheralretinotomy toremovethesubretinal fluid+periretinotomy endolaser +Octafluoropropane (C3F8)forendotamponade
MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT
2 monthspostoperatively
Two months after,macularhole wasclosed but subretinal fluid was stillpresent at the posteriorstaphyloma.
ThepatientwasthensubmittedtoMACULARBUCKLINGSURGERY: AJLmacularbuckle (AJLOphthalmicSpain)
3 monthspostoperatively
Postoperatively it was registered anindentation of the superiormaculabut SD-OCTshowed that inferior
subfoveal fluid persisted.
MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT
1 monthpostoperatively
The macularbuckle was readjusted andmoreinferiorly displaced.
7months after
Onemonth after reintervention,SD-OCTrevealed macularindentation
with nosubretinal fluid orretinoschisis.
MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT
ONTHELASTOPHTHALMOLOGICALAPPOINTMENT:
8 months after
BCVA: OR 20/400Biomicroscopy: pseudophakic, no anteriorchamber reaction
IOP:16mmHg with timolol +brinzolamide +brimonidine
SD-OCT:nosubretinal fluid
Fundoscopy:myopiccoroidosis, closed macularhole,attached retina
MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT
CONCLUSION: Combined vitrectomy with macular buckling is an effective approach in thetreatment of retinal detachments due to macular hole in high myopic patients, improving bothvisual and anatomicoutcomes.
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