Session Title: Vitreo Retinal Surgery I
Session Date/Time: Thursday 11/09/2014 | 08:00-10:00
Paper Time: 09:28
First Author: : Y.Luo UK
Co Author(s): : Z. Mclelland L. da Cruz
Positive Central Scotomas observed after Routine Macula-on Retinal Detachment Surgery
This is a retrospective observational case series from a large tertiary referral vitreoretinal unit.
Four patients presented with positive central scotomas in the immediate post-operative period after routine retinal detachment surgery from 2005 to 2013. All patients underwent otherwise uncomplicated macula-on retinal detachment repair with vitrectomy/ cryo- ± laser-retinopexy/ gas tamponade. The positive scotomas were characterised by patients’ Amsler’s chart drawings and microperimetry findings. The patients also underwent the following investigations to elucidate the cause, with the fellow eye as controls: • Colour and red-free fundus photography • GDx nerve fibre layer analysis • Spectral domain optical coherence tomography (Spectralis®) • Autofluorescence (Spectralis®) • Enhanced depth imaging of choroid (Spectralis®) • Adaptive optics photoreceptors imaging with RTx-1™ camera
All patients described a persistent, well-defined, black /grey distinctive shape in the central vision of their operated eye, noticeable as the anaesthesia subsided, prior to the reabsorption of the gas tamponade. This is reflected in their microperimetry findings as well-demarcated areas of dense scotoma circumscribed by normal thresholds. The GDx nerve fibre layer analysis and choroidal thickness were all within normal limits for all the patients. Autofluorescence imaging was also unremarkable. In one patient, a discrete hyporeflective area in the shape of an “arrow-head” was evident on the red-free fundus photography, which matched the Amsler-drawing of the patient’s scotoma, but was not seen on the colour photography. In this patient, the ellipsoid region (IS-OS junction) was disrupted (with preservation of other retinal layers) within the area of scotoma on OCT, and adaptive optics imaging showed missing photoreceptors in the same region. In all other patients, no abnormality was detected on OCT or adaptive optics imaging.
We described a rare but debilitating complication following routine macula-on retinal detachment repair, characterised by dense positive central scotomas. Photoreceptors loss was shown in one patient and this could represent the severe end of the spectrum of this condition.