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  • Grand Rounds

    A patient with a past ocular history of refractive LASIK/PRK surgery and high myopia presented for evaluation of blurred vision in the left eye. The patient noted vision changes starting 2.5 months prior to presentation but had not noted any changes in vision in the right eye. Exam was notable for BCVA of 20/30 +2 in the right eye and 20/70 +1 in the left eye. Intraocular pressure was 11 and 13 in the right and left eye, respectively. No afferent pupillary defect was noted. Slit lamp exam was notable for a LASIK flap in the right cornea and evidence of prior PRK in the left cornea. There was trace nuclear sclerosis in both lenses. The vitreous was normal. The posterior segment of the right eye had lattice degeneration with holes in all quadrants. There was a six-clock-hour temporal rhegmatogenous retinal detachment that extended posteriorly to approximately 1.5-disc diameters past the vortex veins. This was accompanied by shallow lattice with multiple breaks. The posterior segment of the left eye had similar lattice degeneration with holes in all quadrants. A temporal rhegmatogenous retinal detachment was noted in the temporal retina with macular involvement. The decision was made to proceed with surgery on the left eye due to macular involvement and to observe the right eye as the central vision was unaffected and the detachment was considered chronic. The patient underwent placement of a scleral buckle to the left eye followed by a pars plana vitrectomy to repair the retinal detachment. The patient tolerated the surgery well and was lost to follow up after 2.5 weeks following surgery. The patient’s exam at that time showed a gas bubble in the eye with a flat retina that was healing as expected. The right eye remained stable without propagation of the temporal retinal detachment.

    Presentation Date: 08/24/2023
    Issue Date: 09/01/2023