First Author: P.Tyagi UK
Co Author(s): V. Hegde
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To demonstrate the technique of removal of immature subretinal band on macula through inferior retinectomy in recurrent rhegmatogenous retinal detachment (RRD) secondary to proliferative vitreoretinopathy (PVR) in chronic hepatitis C patient.
Aberdeen Royal Infirmary, Aberdeen, Scotland. United Kingdom.
A 55-year-old emmetropic man presented with superior macula-on RRD associated with two superior horse-shoe tears and vitreous haemorrhage but no PVR. He suffered from chronic Hepatitis C infection. He underwent 23 gauge combined phacovitrectomy with cryopexy and Sulfur hexafluoride (SF6) gas endotamponade. On first post-operative day, the eye was markedly inflamed with fibrin behind intraocular lens. 4 weeks later he developed inferonasal macula-off RRD. He underwent re-do vitrectomy with silicon oil. The inferior retina re-detached under silicon oil with development of PVR membranes and a subretinal band on macula crossing fovea inferiorly. He underwent inferior retinectomy and subretinal band removal.
The subretinal band removal was initially attempted through an inferotemporal retinotomy outside the arcades. The band was very adherent and immature and could not be retrieved through retinotomy. An inferior relaxing retinectomy was performed from 2 to 8 o’ clock to flatten stiff retina. The retinectomy edge was lifted gently with flute cannula to gain access to subretinal band. The band was pulled with forceps with sustained force inferiorly at 6 o’ clock. A part of band snapped near vascular arcades inferior to disc. The remaining part removed by lifting retinectomy at 3 o’ clock.
PVR membranes and subretinal bands are associated with recurrent RRD. Hepatitic C infection is associated with breakdown of blood retinal barrier and could be associated with activating PVR process. Advantages and uses of technique of subretinal band removal through relaxing retinectomy 1) Wider access to subretinal band through both ends of retinectomy 2) removal of immature adherent bands which are otherwise non-yielding through retinotomy, 3) removal of bands that breaks and retract under retina, 4) removal of bands which traverses the macula and areas not suitable for retinotomy.