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Beitragstitel ILM-FLAP achieves closure and retinal re-attachment in macular hole-evoked retinal detachment following complicated cataract surgery
Autor:innen
  1. Jacques Bijon Jules Gonin Eye Hospital - University of Lausanne Präsentierende:r
  2. Jelena Potic Jules-Gonin Eye Hospital, University of Lausanne
  3. Thomas J. Wolfensberger Hôpital ophtalmique Jules-Gonin
  4. Theodor Stappler Hôpital ophtalmique Jules-Gonin
Präsentationsform ePoster
Themengebiete
  • Cataract / Refractive Surgery / Contact Lens
  • Retina Vitreous
Abstract-Text Purpose
Retinal detachments caused by macular holes (MHRD) are an exceedingly rare occurrence; they have been described in highly myopic eyes following cataract surgery. We report a rare case of successful closure and retinal re-attachment in MHRD following a complicated cataract surgery in a non-myopic and non-trauma eye, by using the inner limiting membrane (ILM)-flap surgical technique.

Methods
An 81-year-old female patient presented in the emergency department of the Jules-Gonin Eye Hospital (HOJG) with left eye vision loss dated for a month. She underwent detailed ophthalmological clinical examination supported by OCT diagnostics and secondary evaluation in the vitreoretinal surgery unit.

Results
At presentation, patient’s left eye visual acuity (VA) was counting fingers (CF) with intraocular pressure (IOP) of 10mmHg. Anterior segment (AS) examination showed ptosis and lagophthalmos secondary to a previous facial nerve injury. Pseudoexfoliative syndrome and iridodonesis were present with Artisan intraocular lens (IOL) clipped to the iris in the anterior chamber (AC) and absence of peripheral iridotomy (PI). Posterior segment showed a total, chronic RD with stage B proliferative vitreoretinopathy and MH as the only visible retinal break. Medical records showed evidence of previous complicated cataract surgery with posterior chamber IOL luxation and secondary implantation of an AC IOL (Artisan) in the absence of vitrectomy nor PI, followed by a vitreomacular traction syndrome with spontaneous resolving lamellar macular hole. In HOJG, the patient underwent successful pars plana vitrectomy with ILM peeling, creation of an ILM-flap and silicon oil tamponade. The only retinal break found intraoperatively was a MH. In the short postoperative follow-up (1 month), VA was 0.05/1 with IOP of 7mmHg and calm AS. The retina was fully re-attached with closed MH.

Conclusion
Given the evidence of vitreomacular traction prior to first presentation and the absence of a full vitrectomy during the preceding IOL-exchange surgery, we postulate that it may have been the buildup of unresolved vitreous traction which caused this rare MHRD in a non-myopic and non-trauma eye. The adaptation of the latest vitreoretinal surgical techniques such as the creation of an ILM-flap over an area of total RD managed to achieve not only anatomical MH closure leading to retinal re-attachment, but equally lead to a measurable functional recovery of the patient's central VA.