Management of Long-Standing Macula-Off Rhegmatogenous Retinal Detachment: A Case Report

Abstract

Background Rhegmatogenous retinal detachment (RRD) is an urgent vision-threatening ophthalmic emergency characterized by the separation of neurosensory retina from underlying retinal pigment epithelium secondary to a break in the retina. The disease, if not treated in a timely manner, can cause irreversible loss of vision especially when the macula is involved.Case Presentation: A 24-year-old woman presented with a two-week history of reduced vision in the right eye. There was no history of trauma, ocular surgery or systemic illness. Best-corrected visual acuity (BCVA) was 6/9 in the affected eye that did not improve on pinhole. Anterior segment examination was unremarkable. Fundus examination showed retinal detachment with a single retinal break associated with lattice degeneration. OCT of the macula showed marked retinal thickening with subretinal fluid, cystoid changes and loss of normal foveal contour denoting chronic macula-off rhegmatogenous retinal detachment.Management: The patient was offered surgical intervention with a combined approach of pars plana vitrectomy (PPV), scleral buckling (SB), endo laser photocoagulation and silicone oil tamponade. Follow-up post-op were planned to ensure retinal reattachment and recovery of vision with the removal of the silicone oil.Conclusion: Surgery in patients with RRD that has macular detachment is highly effective in achieving anatomic success and must be performed urgently and aggressively. However, the long-term visual prognosis remains poor in chronic cases secondary to irreversible photoreceptor damage. Improving visual outcomes depends on early diagnosis and appropriate referral.

Keywords

Introduction

 

 

Figure 1: OCT report of  RRD in OD

Sources Image capture by Motorola Edge 60 Pro

• OD- The macular map shows extensive retinal thickening, especially in the central and parafoveal regions.
• OD- Cross-sectional B-scan demonstrates:
  • • • Massive retinal edema.
      • Multiple cystoid spaces.
      • Possible subretinal fluid.
      • Loss of normal foveal contour.
• OS- Central foveal thickness: 229 µm (Within normal range ~250 ± 20 µm).
• OS- Thickness map shows a relatively symmetric pattern.
• OS- B-scan shows:
  • • • Normal macular contour.
      • No cystoid spaces, no subretinal fluid

Diagnosis

• Rhegmatogenous Retinal Detachment (Right Eye)
• Macula-off status
• Lattice degeneration with a single retinal break
• Simple myopic astigmatism (Left Eye)

Management and Follow-Up

1. Ocular Treatment:

• Pars Plana Vitrectomy (PPV): Removal of vitreous gel to relieve vitreoretinal traction, facilitate drainage of subretinal fluid, and allow internal repair of the retinal break.
• Scleral Buckling (SB): Placement of an external band to indent the sclera, reducing traction and supporting retinal reattachment.
• Endolaser Photocoagulation (EL): Application of laser around the retinal break and lattice degeneration to create chorioretinal adhesion and prevent recurrence.
• Silicone Oil Injection (SOI): Use of silicone oil as a long-term intraocular tamponade to maintain retinal attachment during healing.

2. Post-Operative and Follow-Up Care:

• Regular monitoring of retinal attachment status and intraocular pressure.
• Use of topical antibiotics and corticosteroids to control inflammation and prevent infection.
• Monitoring for complications such as proliferative vitreoretinopathy (PVR) or re-detachment.
• Patient education regarding head positioning (if required) and adherence to follow-up schedule.

3. Surgical Consideration:

• Combined surgical approach indicated due to long-standing macula-off retinal detachment.
• Procedure to be performed under local or general anesthesia, depending on patient condition and surgeon preference.
• Silicone oil removal (SOR) planned after 3–6 months once retinal stability is achieved

DISCUSSION

The case highlights the clinical presentation of Rhegmatogenous Retinal Detachment (RRD), the most common form of retinal detachment. RRD occurs due to a wide retinal break that allows vitreous to enter the subretinal space, leading to detachment of the retina from the retinal pigment epithelium (RPE).RRD is linked with posterior vitreous detachment (PVD), vitreoretinal traction, and also predisposing retinal lesions such as lattice degeneration or retinal tears. ^[4,5] Retinal detachment progress can vary depending on the location and type of retinal tear. Retinal tears on the superior side tend to progress rapidly due to gravity, affecting the macula early and leading to sudden visual loss. On the other hand, inferior detachments may have slow progression and usually remain asymptomatic for a very long time. If untreated, RRD can lead to permanent photoreceptor damage and vision loss, which cannot be reversed. Therefore, it is necessary to have regular check-ups and imaging techniques such as fundus evaluation and optical coherence tomography (OCT). Primary management of RRD is surgical, including procedures such as scleral buckling, pars plana vitrectomy, or pneumatic retinopexy, depending on the severity and configuration of the detachment. The prognosis depends on the duration of detachment and whether the macula is involved at the time of intervention.

CONCLUSION

This case enables us to understand the importance of early detection, immediate referral, and appropriate surgical management to preserve visual function. With advances in surgical techniques, the prognosis of retinal detachment has significantly improved, especially when treated before macular involvement. Regular ocular examinations and patient awareness of risk factors play a vital role in preventing delayed presentation and ensuring better visual outcomes.

REFERENCES

1. Mishra C and Tripathy K: Retinal traction detachment, StatPearls Publishing (2023).
2. Shukla UV, Gupta A and Tripathy K: Exudative retinal detachment, StatPearls Publishing (2024).
3. Ahmed F and Tripathy K: Posterior vitreous detachment, StatPearls Publishing (2023).
4. Rasouli M et al.: Incidence of rhegmatogenous retinal detachment post vitrectomy, Canadian Journal of Ophthalmology (2012), 47:262–263.
5. Gupta OP and Benson WE: Risk of fellow eyes in retinal detachment, Current Opinion in Ophthalmology (2005), 16:175–178.
6. Johnston T et al.: Genetic architecture of retinal detachment, Ophthalmic Genetics (2016), 37:121–129.
7. Gupta N and Tripathy K: Retinitis, StatPearls Publishing (2024).
8. Geetha R and Tripathy K: Chorioretinitis, StatPearls Publishing (2023).
9. Sultan ZN et al.: Diagnosis and management of RRD, BMJ Open Ophthalmology (2020), 5:e000474.