Giant retinal tear after pneumatic retinopexy

Abstract

Editor, M ost giant retinal tears are idiopathic (Wilkinson & Rice 1997). Males with pathological myopia are at risk. The second most common cause of giant retinal tears is blunt trauma. Surgical manipulation such as anterior vitrectomy can also be a cause (Wilkinson & Rice 1997). We report a case of giant retinal tear developed after pneumatic retinopexy and illustrate the pathogenesis of this rare and vision-threatening complication. A 54-year-old, non-myopic Chinese man presented with unprovoked floaters in the left eye. Visual acuity (VA) was 20 ⁄ 20 in both eyes. Anterior segments were unremarkable. Fundal examination of the left eye showed a superior rhegmatogenous retinal detachment extending from the 10 to the 2 o’clock position, with a small break and lattice degeneration at 12 o’clock. The right fundus was unremarkable. The patient underwent pneumatic retinopexy with cryopexy around the primary break and injection of 0.3 mL 100% C3F8 gas. Postoperatively, sitting upright with facedown posture was recommended. Ten days later, the superior retinal detachment was completely reattached. However, a giant retinal tear extending from 12 to 4 o’clock with pars plana detachment was noted (Figs 1 and 2). Scleral buckling, pars plana vitrectomy, perfluorocarbon liquid, endolaser, cryopexy and 20% SF6 gas)fluid exchange were performed. The retina remained flat with VA of 20 ⁄ 70 at 8 months postoperatively. There was mild nuclear sclerosis pending cataract extraction. Pneumatic retinopexy is a safe retinal reattachment procedure involving the transconjunctival injection of gas into the vitreous cavity, cryopexy or laser retinopexy, and posturing. Complications of this procedure are rare, and consist of new retinal break formation, subconjunctival gas, subretinal gas, gas entrapment at the pars plana, shift of detachment into previously attached macular and