Combined brachytherapy and vitreoretinal surgery for a large retinal capillary hemangioma with exudative retinal detachment

Introduction: We report about a large retinal capillary hemangioma (RCH) with exudative retinal detachment and a macular fold, treated with Ruthenium-106 brachytherapy (Ru-106 BT) and scleral buckling surgery, followed by pars plana vitrectomy (PPV), for the removal of macular tractions. Case description: A 17-year-old boy was referred to our Ocular Oncology Unit for a large RCH in the left eye. BCVA was hand motion. The RCH measured 4.9 × 6.85 mm in basal diameters and 4.0 mm in thickness and was located in the mid-peripheral temporal retina. It was surrounded by extensive subretinal exudation, forming an exudative retinal detachment, with a retinal fold that extended from the lesion to the optic disc. We performed Ru-106 BT and at the moment of the plaque removal we placed a radial buckle with the aim to unbend the retinal fold. At 3-months follow-up the exudation decreased, we achieved the opening of the peripheral side of the retinal fold, but the macula was still detached. We decided to perform a lens sparing PPV, macular peeling and air tamponade, to remove the vitreoretinal tractions ab interno and to try to complete the opening of the macular fold. After 1-month BCVA was counting fingers, the retina appeared attached, also in the macular area, but the retinal fold remained partially close in the macular side. After 6 months the tumor was inactivated, the macula remained attached, unfortunately, the macular fold remained partially close. Conclusion: Ru-106 BT and scleral buckling concurrent approach can be an effective treatment modality in selected cases of large RCHs, followed by PPV to remove eventual vitreo-retinal tractions.

Surgical Repair of a Persistent Full-Thickness Macular Fold With Base-to-Base Photoreceptor Apposition Secondary to Hypotony From Trabeculectomy Surgery and Postoperative Laser Suturelysis

Purpose: To report the successful repair of a persistent full-thickness retinal fold secondary to hypotony from trabeculectomy surgery. Results: Laser suturelysis was performed on a patient to relieve an elevated intraocular pressure posttrabeculectomy surgery. This resulted in chronic hypotony, a full-thickness retinal fold, and a decline in visual acuity to “count fingers.” The patient underwent a pars plana vitrectomy with internal limiting membrane peeling, subretinal injection of balanced saline solution, fluid-air exchange, injection of F-Decalin, peripheral retinotomy, endolaser photocoagulation, and vitreous substitution with 15% C3F8 gas. Anatomic improvement was documented via multimodal imaging. Six months postoperatively best-corrected visual acuity (BCVA) returned to 20/30. Conclusions: We describe a surgical approach to full-thickness retinal folds and review the management options previously reported in the setting of hypotony. We provide support for the active management of appositional full-thickness retinal folds involving the fovea and demonstrate that surgical correction can significantly improve BCVA even after 4 months of hypotony.

Optical Coherence Tomography Findings of Retinal Folds in Nanophthalmos

Aim. To report the optical coherence tomography (OCT) findings in three members of the same family with nanophthalmos associated with elevated papillomacular retinal fold.Methods. Complete ophthalmic examination as well as ultrasonography and OCT was performed in all patients.Results. Axial lengths ranged from 16.75 mm to 17.48 mm and refractive errors ranged from +17.50 D to +20.50 D. Main fundus findings were the hyperopic crowded, cupless optic disc, and retinal fold through papillomacular region. Macular OCT scans revealed retinal fold with normal retinal pigment epithelium and choriocapillaris.Interpretation. It is presumed that the retinal folds in nanophthalmos result from a redundancy of the retinal layer caused by retarded growth of the scleral, choroidal, and retinal pigment epithelial layers. The anatomic information provided by the current study is consistent with this thesis.