Journal of Pediatric Ophthalmology and Strabismus

Short Subjects 

Optical Coherence Tomography Findings in Delayed Subretinal Fluid Absorption After Scleral Buckling Surgery

Gurdeep Singh, DNB, FRCS; Veerappan Rathinasapathy Saravanan, DNB, FRCS; Venkatapathy Narendran, DO, DNB; Kalpana Narendran, DO, DNB

Abstract

The occurrence of loculated bleb-like delayed subretinal fluid absorption has been reported following scleral buckling surgery and more commonly following pneumatic retinopexy among adults and seldom in children. The authors report the occurrence of delayed subretinal fluid absorption following scleral buckling surgery for rhegmatogenous retinal detachment in a 15-year-old girl, indicating the need for routine optical coherence tomography evaluation in the non-amblyogenic age group of children who have good anatomical but poor functional outcome following retinal reattachment surgery.

Abstract

The occurrence of loculated bleb-like delayed subretinal fluid absorption has been reported following scleral buckling surgery and more commonly following pneumatic retinopexy among adults and seldom in children. The authors report the occurrence of delayed subretinal fluid absorption following scleral buckling surgery for rhegmatogenous retinal detachment in a 15-year-old girl, indicating the need for routine optical coherence tomography evaluation in the non-amblyogenic age group of children who have good anatomical but poor functional outcome following retinal reattachment surgery.

From the Departments of Pediatric Ophthalmology (GS, KN) and Retina and Vitreous Services (VRS, VN), Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Avinashi Road, Coimbatore – 641 014, Tamil Nadu, India.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Gurdeep Singh, DNB, FRCS, Department of Paediatric Ophthalmology, Aravind Eye Care System, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Avinashi Road, Coimbatore – 641 014, Tamil Nadu, India.

Received: September 11, 2006
Accepted: November 01, 2006

Introduction

The occurrence of loculated bleb-like delayed subretinal fluid absorption has been reported following scleral buckling surgery and, more commonly, following pneumatic retinopexy.1,2 We describe a 15-year-old girl who had a poor clinical outcome 6 months after surgery despite good anatomical success. Optical coherence tomography (OCT) revealed delayed subretinal fluid absorption as the cause of defective vision.

Case Report

A 15-year-old girl who underwent scleral buckling surgery in her left eye for rhegmatogenous retinal detachment involving the macula due to lattice with atrophic holes came for regular follow-up 6 months after surgery with complaints of persistent distortion and defective vision. Her best-corrected visual acuity was 20/60 in the left eye. The anterior segment was normal. On fundus examination, the posterior pole and the fovea appeared normal on indirect ophthalmoscopy and slit-lamp examination using the +90 diopter lens (Fig. 1A). In the area of previous detachment in the inferior quadrant, multiple raised bleb-like lesions simulating multiple pigment epithelial detachments (Fig. 2A) were seen. OCT (Zeiss Stratus; Carl Zeiss Meditec, Dublin, CA) showed the presence of localized subretinal fluid under the fovea (Fig. 1B). Multiple areas of localized neurosensory detachment ranging from ¼ to ½ disc areas were also seen in the area of previous retinal detachment (Fig. 2B).

(A) Fundus Photograph of the Posterior Pole of the Left Eye. (B) Optical Coherence Tomography Image of the Left Eye Showing the Neurosensory Detachment of the Fovea (white Arrow) and Temporal Pockets of Subretinal Fluid (red Arrows).

Figure 1. (A) Fundus Photograph of the Posterior Pole of the Left Eye. (B) Optical Coherence Tomography Image of the Left Eye Showing the Neurosensory Detachment of the Fovea (white Arrow) and Temporal Pockets of Subretinal Fluid (red Arrows).

(A) Fundus Photograph of the Inferior Retina of the Left Eye Showing the Bleb-Like Lesions (black Arrow). (B) Optical Coherence Tomography Image of the Inferior Retina Showing the Bleb-Like Neurosensory Detachments (White Arrows).

Figure 2. (A) Fundus Photograph of the Inferior Retina of the Left Eye Showing the Bleb-Like Lesions (black Arrow). (B) Optical Coherence Tomography Image of the Inferior Retina Showing the Bleb-Like Neurosensory Detachments (White Arrows).

Discussion

Several reasons have been postulated as possible causes for delayed subretinal fluid absorption following retinal detachment surgery, including chronicity of the retinal detachment, presence of subretinal precipitates, and excessive cryopexy during surgery leading to choroidal vascular insufficiency. This phenomenon is well known to retinal surgeons who routinely perform non-drainage scleral buckle operations and pneumatic retinopexy and the reported incidence is 4.3% over a 5-year period.1,3 Our patient had non-drainage scleral buckling surgery and excessive cryopexy.

Delayed subretinal fluid absorption has been described to occur in diffuse and localized forms.2,4,5 In the diffuse form, the subretinal fluid persists in the inferior quadrant (usually in a more dependent area), which tends to shift and takes several months to reabsorb. In the localized form, the fluid may involve the macula, tends to be subtle, does not shift, and may be difficult to detect on indirect ophthalmoscopy. These localized pockets, which occur in the absence of open retinal breaks, resemble serous pigment epithelial detachments, range from 1 to 3 disc diameters in size, and may be associated with subretinal precipitates.4,5 The phenomenon of shallow loculated delayed subretinal fluid absorption that was seen in our patient is sufficiently different and subtler than typical residual fluid associated with non-drainage procedures as previously described.6

Loculated pockets of subretinal fluid in the macula have been described to adversely affect the visual prognosis.2,7 These patients have bothersome postoperative symptoms, which include visual fluctuation, “haze,” and metamorphopsia. Our patient had these symptoms but the macula appeared normal on slit-lamp and indirect ophthalmoscopy except for the small pockets of subretinal fluid in the inferior quadrant in the area of previous retinal detachment. The patient had poor visual outcome despite good anatomical success.

OCT detected the macular pathology and the cause of poor vision in our patient. This indicates the need for routine OCT evaluation in the non-amblyogenic age group of children who have good anatomical but poor functional outcome following scleral buckling surgery for rhegmatogenous retinal detachment.

References

  1. Robertson DM. Delayed absorption of subretinal fluid after scleral buckling procedures. Am J Ophthalmol. 1979;87:57–64.
  2. Chan CK, Wessels IF. Delayed subretinal fluid resorption after pneumatic retinopexy. Ophthalmology. 1989;96:1691–700.
  3. Desatnik H, Alhalel A, Treisher G, Moisseiev J. Management of persistent loculated subretinal fluid after pneumatic retinopexy. Br J Ophthalmol. 2001;85:189–192. doi:10.1136/bjo.85.2.189 [CrossRef]
  4. Ambler JS, Zegarra H, Meyers SM. Chronic macular detachment following pneumatic retinopexy. Retina. 1990;10:125–130. doi:10.1097/00006982-199004000-00007 [CrossRef]
  5. Tornambe PE. Pneumatic retinopexy. Surv Ophthalmol. 1988;32:270–281. doi:10.1016/0039-6257(88)90175-0 [CrossRef]
  6. Avins LR, Hilton GF. Lesions simulating detachment of the pigment epithelium: occurrence after retinal detachment surgery. Arch Ophthalmol. 1980;98:1427–1429.
  7. Kaga T, Fonseca RA, Dantas MA, Yannuzzi LA, Spaide RF. Optical coherence tomography of bleb-like subretinal lesions after retinal reattachment surgery. Am J Ophthalmol. 2001;132:120–121. doi:10.1016/S0002-9394(00)00950-8 [CrossRef]
Authors

From the Departments of Pediatric Ophthalmology (GS, KN) and Retina and Vitreous Services (VRS, VN), Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Avinashi Road, Coimbatore – 641 014, Tamil Nadu, India.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Gurdeep Singh, DNB, FRCS, Department of Paediatric Ophthalmology, Aravind Eye Care System, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Avinashi Road, Coimbatore – 641 014, Tamil Nadu, India.

Received: September 11, 2006
Accepted: November 01, 2006

10.3928/01913913-20090101-22

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