0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Observation |

Management of Persistent Subretinal Fluid Following Retinal Detachment Repair

David A. Reichstein, MD1; Brian P. Larsen, MD1; Judy E. Kim, MD1
[+] Author Affiliations
1Department of Ophthalmology, Medical College of Wisconsin, Milwaukee
JAMA Ophthalmol. 2013;131(9):1240-1244. doi:10.1001/jamaophthalmol.2013.2518.
Text Size: A A A
Published online

Extract

Persistent subretinal fluid (PSRF) affecting the macula may be a source of vision loss following repair of rhegmatogenous retinal detachment (RRD), regardless of the preoperative status of the macula or the type of surgery used to repair the detachment. Optical coherence tomography (OCT) has been used to visualize PSRF following RRD repair, and the amount of PSRF often correlates with the postoperative visual acuity (VA).13 The management of PSRF following repair of RRD has typically been observation because PSRF often resolves.3 We report 3 different managements and outcomes of PSRF following RRD repair in 3 patients, with a focus on the use of OCT in the early postoperative period to guide management.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
/>
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Patient 1

A, Vertical optical coherence tomography through the fovea 2 months following vitrectomy, perfluorocarbon injection, air-fluid exchange, and 20% sulfur hexafluoride gas injection for macula-off rhegmatogenous retinal detachment demonstrates multiple pockets of persistent subretinal fluid. B, Vertical optical coherence tomography through the fovea 4 months following surgery demonstrates decreased subretinal fluid with observation alone. C, Vertical optical coherence tomography through the fovea 7 months following surgery demonstrates no significant subretinal fluid with observation alone, although some intraretinal edema has appeared. D, Vertical optical coherence tomography through the fovea 18 months following surgery demonstrates resolution of subretinal and intraretinal fluid. Visual acuity (VA) at this time was 20/25.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Patient 2

A, Vertical optical coherence tomography through the fovea 2 months following scleral buckling, cryoretinopexy, and 20% sulfur hexafluoride gas injection for a macula-splitting retinal detachment demonstrates pockets of persistent subretinal fluid. B, Vertical optical coherence tomography through the fovea 15 months following surgery demonstrates continued accumulation of persistent subfoveal fluid despite an attempt at pneumatic displacement with intravitreal injection of 20% sulfur hexafluoride gas and prone positioning. Note the thinned retina centrally. C, Vertical optical coherence tomography through the fovea 3 years following surgery demonstrates a full-thickness macular hole. D, Vertical optical coherence tomography through the fovea 2 months following pars plana vitrectomy, membrane stripping, air-fluid exchange, and instillation of sulfur hexafluoride gas demonstrates resolution of subretinal fluid and a closed macular hole. However, the retina was thinned centrally with atrophy of the outer retina. Visual acuity (VA) did not improve considerably despite the macular hole closure.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Patient 3

A, Horizontal optical coherence tomography through the fovea 2 months following 23-gauge pars plana vitrectomy with cryopexy, air-fluid exchange, and placement of 15% octafluoropropane gas for chronic macula-sparing temporal retinal detachment demonstrates persistent subfoveal fluid. B, Horizontal optical coherence tomography through the fovea 6 months following surgery demonstrates continued accumulation of subretinal fluid despite prolonged observation. C, Horizontal optical coherence tomography through the fovea following displacement with subretinal balanced salt solution injection and 20% sulfur hexafluoride gas placement demonstrates complete resolution of persistent subfoveal fluid. Cataract prevented excellent vision at this time. D, Horizontal optical coherence tomography performed 13 months following the initial operation and 1 month following cataract surgery demonstrates continued resolution of fluid. Visual acuity (VA) at this time was 20/20.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();