|Year : 1982 | Volume
| Issue : 6 | Page : 585-586
Clinical features and management of retinal detachment with massive vitreous collapse and acute hypotony
Bijayananda Patnaik, Rajinder Kalsi
Retina Associates, New Delhi, India
Retina Associates. 203, Sethi Bhawan, 7, Rajendra Place, Pusa Road, New Delhi-110008
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Patnaik B, Kalsi R. Clinical features and management of retinal detachment with massive vitreous collapse and acute hypotony. Indian J Ophthalmol 1982;30:585-6
There are some types of rhegmatogenous retinal detachments which are difficult to treat successfully. Retinal detachment with extreme low ocular pressure, is one such condition. This presentation is a report on a series 30 such cases, their methods of management, course and results.
| Materials and methods|| |
Patient presents with sudden loss of vision due to retinal detachment, usually a myope (16 cases) often an aphakic (18 cases). The remarkable clinical feature is an extreme low intraocular pressure, often unrecordable on a schiotzs tonometer or records an intraocular pressure of 7-to `0' m Hg by applanation tonometer. Sometimes globe can be seen to be collapsing under the pressure of extraocular muscles. This fall in I.O.P often sets in after bed rest. There is a strong aqueous flare. The pupil does not dilate well Media are hazy specially due to a characteristic dense vitreous condensation forming "sattelites in cobweb" picture. Very often there are variable extent of choroidal detachments. The extreme low
tension leads to distortion of the globe which throws the retina into wild folds. The whole retina shows rows upon rows of tenting folds, the multiple sites of vitreo-retinal adhesions. The retinal breaks loose themselves among the various folds in the retina and are extremely difficult to locate and localise. Left to itself, there appears a great tendency for pre-retinal gliosis. Thus 24 (80%) out of 30 cases in this series had or developed pre-retinal gliosis during the period of observations.
There were 26 males and 4 females. Right eye was involved in 20 out of 30 cases. The other eye was normal in 13. The rest, either showed Vitreo-retinal degeneration (14) or were blind (3).
| Observations and discussion|| |
The greatest difficulty is of indentifying and localising the retinal breaks mostly due to innumerable irregular folds on the retina as a consequence of acute hypotony. Though in 26 cases (80%) retinal breaks were detected, one was not sure wheather other tears were not missed. The densely condensed vitreous adds to the problem of effective examination and localisation of retinal breaks.
In the presence large choroidal detachments it is not possible to create choroidal inflammation as a step towards retinopexy.
Therefore it becomes very important that 1. The choroidal detachment settles, 2. The intraocular pressure is build up.
Management : With oral steroids (of 30-40 mg of prednisolon) it is possible in most cases to settle the choroidal detachments.
However, the building up of intraocular pressure to the satisfaction of the surgeon is less often achieved. In favourable cases frequent local drops of corticosteroids is often adequate.
Surgery was not attempted in 30`;% of cases where evidence of advanced pre-retinal glosis was existing. All 21 cases were operated with an encircling procedure where cryo was used for retinopexy. Inspite of very prominent buckles retina did not settle in 9 cases (43%). Of the 12 cases where retina had initially settled, 5 cases had a recurrence. The long term success rate was thus reduced to 33%. The results was poor even though 67% of cases were received within 4 wks of loss of vision and 20% of cases had sought treatment within a week. All the cases of failure were due to pre-retinal gliosis and massive vitreous retraction (M.V.R). The typical sequence of events were persistent hypotony and choroidal detachments after surgery. The exudative reaction sometimes becomes marked with yellowish green reflex. Generally cases which respond promptly to small dosage of steroids carry a better prognosis.
Even in cases where retina was settled, the visual acuity remained poor in more than half (57%) of them. Of the 7 cases where retina settled 4 had counting finger close to face or less 2 cases had 6/9 vision and one had 6/24 vision.