Operculated Retinal Tear
35 years old complaining from floaters .What is your Diagnosis and Management?
By Dr.Juan Jose Cueto Gomez Photocoagulation 3 rows around it. Is he a myope? Search for more lesions.
By Dr.Danilo Iannetta Retinal tear with perilesional edema and i can see the anterior shadow in the vitreous but i can’t see if it’s operculum or if the traction is still active. In second case more than others evaluate Laser treatment.
In the majority of patients, the vitreous gel separates completely and without problems. In some patients, however, the vitreous is more adherent, and the separation can cause a tear in the retina. These tears are often small and located in the peripheral retina, an area which is not typically used for vision. Therefore, decreased vision from a tear alone is highly unusual, and often the only symptoms produced by a retinal tear are flashes and/or floaters. It does not cause pain or redness of the eye. This is why anyone with flashes or the sudden onset of new floaters should be examined. Most, but not all, retinal tears should be treated. Typically, symptomatic retinal tears are treated while asymptomatic round holes can be safely observed. Patients at especially high risk for a detachment (nearsighted, history of detachment in the other eye) are often treated prophylactically. Treatment for a retinal tear is aimed at creating an adhesion between the retina and underlying choroid and RPE. This can be done in two ways depending on the size and location of the tear(s).
- Laser – if the tear is posterior enough and there is no intervening vitreous hemorrhage, laser can be used to “spot weld” the retina to the underlying choroid and RPE. Enough burns to create 3-4 rows of laser spots around the tear(s) are made. Topical anesthetic drops are applied and a contact lens is used to focus the laser on the retina. Activity is limited for at least 1 week until the laser scars become strong enough to be considered “permanent.”
- Cryotherapy – if the tear is anterior or if there is intervening vitreous hemorrhage that prevents the entire tear from being visualized, the tear is frozen using a cryoprobe. Topical anesthetic is given first, followed by subconjunctival injection of lidocaine (a local anesthetic). Under visualization with an indirect ophthalmoscope, liquid nitrogen is used to freeze around the tear from the outside of the globe. The eye is generally patched for a couple of hours. Activity is limited for up to 2 weeks because the cryotherapy scars take slightly longer to become “permanent.”