Progressive retinal detachment secondary to juxtapapillary microholes in association with type 3 posterior staphylomas

Figures & data

Figure 1 Fundus diagrams of retinal detachments at presentation and ocular parameters.

Table 1 Summary of clinical characteristics, management, and outcomes

Cases presenting before 2006
Case	Clinical presentation	Preoperative findings	Intraoperative findings	Procedure	Final outcome
1	72-year-old Right eye BCVA: CF Lens status: phakic 2-week history of reduced vision and floaters	Posterior staphyloma with an inferior macular involving RD	Microhole at 4 o’clock within nasal PPA	3PPV Endolaser 5000cs silicone oil	Permanent silicone oil BCVA: 20/400
2	67 years old Left eye BCVA: 20/40 Lens status: Pseudophakic 10-day history of floaters and superior visual-field defect	Posterior staphyloma Inferonasal macular sparing RD	Microhole at 11 o’clock within nasal PPA	3PPV, no laser, C3F8 Re-detached Repeat procedure: 5000cs silicone oil	Permanent silicone oil BCVA: 20/200
3	80 years old Right eye BCVA: 20/100 Lens status: phakic 3-week history of floaters and visual-field defect	Posterior staphyloma Macula-involving inferior RD	Microhole at 2 o’clock within nasal PPA	3PPV, no endolaser, 5000cs silicone oil Repeat procedure: Silicone oil removal 5 years later	Retina remains attached 3 years post-silicone oil removal BCVA: 20/125
Cases presenting after 2006
4	60 years old Left eye BCVA: 20/32 Lens status: phakic 1 -week history of floaters	Type 3 posterior staphyloma Nasal RD not extending to the ora serrata	Microhole at 11 o’clock within nasal PPA	3PPV, endolaser, C2F6 gas tamponade	Retina remains attached 3 years post-surgery BCVA: 20/40
5	68 years old Right eye Lens status: phakic BCVA: 20/125 2-week history of floaters	Type 3 posterior staphyloma Inferior RD	Microhole at 4 o’clock, within nasal PPA, discovered at second operation	Cryotherapy to suspicious areas plus scleral buckling with encirclement Second procedure: 3PPV, endolaser, and C2F6	Retina remains attached 2 years post-surgery BCVA: 20/200
6	78 years old Right eye BCVA: 20/80 Lens status: Pseudophakic 2-week history of PVD symptoms	Type 3 posterior staphyloma Inferior RD Preop OCT: microhole measuring 121μm within nasal PPA	Microhole at 2 o’clock within nasal PPA	3PPV, endolaser, and C2F6	Retina remains attached 6 months post-surgery BCVA: 20/63
7	82 years old Left eye BCVA: HM Lens status: Pseudophakic 2-week history of PVD symptoms	Total RD Associated with choroidal hemorrhage	Microhole within nasal aspect of PPA	3PPV, endolaser, and C2F6	Retina remains attached 7 months post-surgery BCVA: CF

Abbreviations: 3PPV, three-port pars plana vitrectomy; BCVA, best-corrected visual acuity; CF, counting fingers; HM, hand movements; OCT, optical coherence tomography; PPA, peripapillary atrophy; preop, preoperative; PVD, posterior vitreous detachment; RD, retinal detachment.

Figure 2 Intraoperative photograph during drainage of subretinal fluid through juxtapapillary microhole in Case 4. Note proximity of drainage site to retinal vein.

Figure 3 Preoperative optical coherence tomography image of Case 6 showing full-thickness juxtapapillary microhole (white arrow).

Figure 4 Postoperative optical coherence tomography images of (A) Case 7, (B) Case 4, and (C) Case 5 showing type 3 posterior staphyloma (outlined with dashed red line). Note retinal vascular folds (red arrows) and attenuated choroid and retinal pigment epithelium (white arrow).