Ophthalmology Series: Case 2

ANSWERS IN REPLY BOX BELOW

A 43 year-old male presents with a four day history of floaters, flashing lights and then a dense, curtain-like field loss.
Slit lamp examination reveals:
Slit lamp photograph showing retinal detachment in Von Hippel-Lindau disease EDA08.JPG

Fundoscopy reveals:
Image result for rhegmatogenous retinal detachment fundoscopy

1. What is the most likely diagnosis in this patient ?
(Hint: inspect the fundoscopy result to delineate which type is present)

2. Outline the pathology seen in this type.

3. List all the possible risk factors for developing this condition ?

4. What are the treatment options in this patient ?

5. What is the major determining factor of the prognosis ?

Source: http://emedicine.medscape.com/article/798501-overview

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2 thoughts on “Ophthalmology Series: Case 2

  1. ANSWERS
    1. Rhegmatogenous Retinal Detachment. Note the floating, diaphronous membrane which partly obscures the choroidal vascular detail. A bullous retinal detachment is seen with marked accumulation of fluid in the subretinal space.
    2. A tear occurs in the retina, allowing liquefied vitreous to gain entry to the subretinal space. This causes progressive rhegmatogenous retinal detachment which may be partial or total.
    3. RISK FACTORS: High myopes, previous cataract surgery, retinal detachment in fellow eye, recent severe eye trauma.
    4. Two major surgical techniques to repair retinal detachment. The external approach with sclerostomy is done by closing the tear by indenting the sclera with a strip of silicone sponge. An internal approach or vitreoretinal surgery involves removal of the vitreous with a microsurgical cutter.
    For prophylaxis, laser or cyroprope are used.
    5. Macular attachment.
    If the macula is attached and surgery successfully reattaches the peripheral retina, the outlook for vision is excellent. However, if detached for over 24 hours, the chances of retaining visual acuity are significantly reduced.

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