We don't have to tell you that things don't always go as planned. It is rare that you get to show up to the office and see a full slate of patients without an employee calling in sick, technology issues rearing their ugly head, or a complicated case delaying your schedule. But occasionally, something arises that throws your entire day off. We are reminded of this on a Saturday morning when we get a text from a referring doctor who is seeing a patient with a retinal detachment. The macula is attached and requires urgent intervention. Vision America's Dr. Dale Brown meets the patient at our Homewood office for evaluation. Here's what we have: Symptoms A 64-year-old male presents with a three-day history of progressive loss of vision in the right eye. He does not report any pain or redness, but does report a recent onset of floaters. Previous History Medical History: Hypercholesterolemia, Hypertension Past Ocular History: Cataract Surgery in each eye. Social History: Occasional glass of wine, no drug or tobacco use. Medications: Aspirin, crestor, dydrochlorothiazide, pindolol. Allergies: NKDA Review of systems: Negative Base Exam Findings Uncorrected Visual Acuity: OD 20/25 OS 20/20 Pupils - dilated upon arrival IOP - 19 mmHg OD / 20 mmHg OS Anterior Segment Findings Lids / Lashes Normal OU Conjunctiva Normal OU Cornea Normal OU AC Deep and Quiet OU Iris Normal OU Lens PCIOL OU, well centered with clear PC Dilated Fundus Examination Nerve OD C/D .3 with normal color and contour Macula OD Normal and attached Vessels OD Normal Periphery OD retinal hole @ 1:00 with associated detachment from 11:00 to 1:00, lattice degneration 360 degrees Diagnostic Testing Fundus Photo - superior retinal detachment with attached macula. Diagnosis Rhegmatogenous Retinal Detachment, right eye. Management Pneumatic Retinopexy in the office on the same day. At five days post op, uncorrected VA stable at 20/25. Retina is attached under gas bubble (see image below). Additional laser treatment is applied. Patient proceeds without complications. Discussion / Challenges
Pneumatic retinopexy was first described by Hilton and Grizzard in 1986 as an outpatient procedure to repair rhegmatogenous retinal detachments. (1) It involves a two-step procedure. Intraocular gas is injected into the vitreous cavity and the patient is positioned to allow the gas bubble to reattach the retina. Following reattachment, laser treatment is applied to the retinal break. Indications
(205) 943-4600. (1) Hilton GF, Grizzard WS. Pneumatic retinopexy (a two-step outpatient operation without conjunctival incision). Ophthalmology. 1986;93:626-641. (2) Holz ER, Mieler WF. View 3: The case for pneumatic retinopexy. Br J Ophthalmol. 2003;87:787-89.
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11/6/2023 12:31:28 am
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