OSLI Retina

December 2019

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November 2019 · Vol. 50, No. 11 791 ■ T E C H N I Q U E ■ Cryotherapy and Pneumatic Retinopexy in Schisis-Related Retinal Detachment Radwan Ajlan, MBBCh, FRCS(C); Deena Shaath, BA; Michael Gilbert, MD ABSTRACT: A 57-year-old female presented with macula-involving retinal detachment secondary to degenerative retinoschisis. She was repaired with transscleral cryotherapy to both inner and outer retinoschisis breaks followed by intravitreal sul- fur hexafluoride (SF 6 ) gas injection and anterior chamber paracentesis. Postoperative imaging at 4 months showed preserved fovea and completely attached retina. To the best of the authors' knowl- edge, this is the first report in the literature treating retinoschisis-related detachment with this mini- mally invasive technique without subretinal fluid drainage. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:791-794.] INTRODUCTION Degenerative retinoschisis results from acquired microcystoid degeneration of the neurosensory retina leading to abnormal splitting of the retinal layers. The prevalence of this condition has been estimated to be 3.9% in people between the ages of 60 and 80 years 1 and has been reported in patients as young as age 20. 2 Retinoschisis is typically asymptomatic and general- ly is only treated upon the rare occurrence of progres- sion to retinal detachment. Multiple surgical tech- niques have been used to repair such detachments, most commonly scleral buckling and pars plana vit- rectomy (PPV), 3-6 with no consensus on the procedure of choice. 7 This case demonstrates successful repair of retinoschisis-related retinal detachment using ex- clusively minimally invasive techniques: cryothera- py to both inner and outer retinal breaks, pneumatic retinopexy (PR) using sodium hexafluoride (SF 6 ) gas, and no subretinal fluid (SRF) drainage. TECHNIQUE A 57-year-old female with a past ocular history of degenerative retinoschisis presented complaining of seeing a "pop of ink" and flashes in her right eye vi- sion starting 1 week prior with a progressive increase in floaters. Right eye (OD) clinical exam revealed a Snellen visual acuity (VA) of 20/40, inferotemporal visual field defect by confrontational exam, and mild nuclear sclerosis on anterior segment exam. Posterior segment exam showed a superotemporal retinal de- tachment subtending approximately 4 clock hours and extending posteriorly within the superior vas- cular arcade, with visible inner retinal holes periph- From the Department of Ophthalmology, University of Kansas School of Medicine, Kansas City (RA, MG); and School of Medicine, University of Kansas, Kansas City (DS). Originally submitted March 3, 2019. Revision received March 3, 2019. Accepted for publication July 3, 2019. The authors report no relevant financial disclosures. Address correspondence to Radwan Ajlan, MBBCh, FRCS(C), Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Suite 100 KU Eye, Prairie Village, KS 66208; email: rajlan@kumc.edu. doi: 10.3928/23258160-20191119-07

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