Management of retinal detachment in block related globe perforation with pneumatic retinopexy
A 62-year-old male presented to our out-patient department with history of cataract surgery in the left eye 4 week back, followed by no improvement in vision and onset of floaters after surgery. Now, he was complaining of temporal field defect in the involved eye. On examination, patient had retinal detachment involving nasal retina with 2 irregular tears along superonasal arcade. Best corrected vision at presentation was 20/30. Resolving vitreous hemorrhage was present in the inferior vitreous. There was no vitreous traction upon any of the breaks. Posterior vitreous detachment (PVD) was complete as demonstrated by B-scan ultrasonography. As the break was posterior and the macula was attached, 2-stage pneumatic retinopexy was planned.\nAfter achieving hypotony with 350 ml of intravenous mannitol 20% over 45 minutes, the patient was taken up to the operating room. After cleaning the eye locally with povidone-iodine 10% solution, a sterile surgical drap was applied. Anterior chamber paracentesis was done with 26G needle. 0.3 ml of pure C3F8 was injected intravitreally through pars plana route 3.5 mm from limbus infero-temporally. Retinal artery pulsations were checked, and the eye was patched. The patient was advised prone position. After 24 hours of tamponade, retina was reattached. Laser barrage of the breaks was done using Laser Indirect Ophthalmoscope, [], and prone position was advised for 3 more days. Intra-ocular pressure was monitored every 6 hourly for the first 3 days.\nAt 4 weeks [] and 8 week [] follow-up, the retina remained attached. Inferior vitreous hemorrhage resolved and vision remained stable at 20/30.