Posters

Acute, postoperative, transient retinal detachment (APTRD) after anterior and combined anterior/posterior segment intraocular surgery: a new entity

Poster Details

First Author: H. Gerding SWITZERLAND

Co Author(s):                        

Abstract Details

Purpose:

To describe and analyze a recently discovered and so far not reported new type of transient flat macular retinal detachment presenting early after intraocular anterior segment, or combined intraocular surgery.

Setting:

Retrospective analysis and description of an institutional collection of cases with APTRD observed in a single tertiary care unit.

Methods:

After case 1, files of the last 5 years were checked for APTRD after cataract surgery. Prospectively all eyes were screened by SD-OCT (Spectralis) within two days after vitrectomy with/without anterior segment surgery. The Stellaris PC (Bausch&Lomb) was used for all interventions. 30° vertically/horizontally scans and 20°x20° volume scans taken. Eyes with APTRD were re-examination at least on the next day, after 1 week and then individually scheduled as long as APTRD or secondary changes could be detected. In addition to SD-OCT scans, all visits included determination of best corrected visual acuity, anterior segment biomicroscopy, Goldmann tonometry, and binocular funduscopy.

Results:

APTRD was discovered in 6 eyes/6 patients (41-87 years) on day 1-2 postoperatively. Related interventions: Case (C) 1&2: phacoemulsification & posterior chamber lens implantation (PE&PCL) (C2 after previous ppV), C3: PE&PCL&ILM-peeling, C4&5: ppV&sulcus-fixation (SF) of subluxated PCLs, C6: ppV&lensectomy&SF after traumatic lens dislocation. C1 presented signs of tractional effects related to PE. APTRD of C3 was associated to the margin of ILM-removal. In all other eyes APTRD was localized in peripheral macula, parallel or underneath major or second order vessels. In all eyes shallow RDs resolved until day 2-10 postoperatively. In eyes with foveal APTRD visual acuity improved to 20/20.

Conclusions:

APTRD represents an entity so far not reported in literature. Postoperative OCT-finding in cases 1 and 3 indicate a causal role of direct traction forces on the retina. In all other eyes the etiology remains unclear. One explanation may be that major variations of intraoperative pressure may cause mechanical stretching of the retina within the macula resulting in flat retinal detachments. The spatial relation of detachments to the anatomy of retinal vessels suggests that mechanical stabilization of vessels may perhaps determine the localisation of APTRD along and underneath vascular structures.

Financial Disclosure:

NONE