History
A 60 year-old male visited the Retina Institute of Hawaii complaining of poor central vision in the right eye. He began to notice vision loss inferiorly one week prior, which progressed to central vision loss two days prior to exam. The patient was CF with eccentric viewing.
Examination
Upon a dilated fundus examination, there was a macula-off superior Rhegmatogenous Retinal Detachment with a superotemporal horse-shoe tear. optomap® plus images were captured to document the retinal detachment and horseshoe tear and assist in explaining the treatment plan to the patient. A pneumatic retinopexy was immediately performed which reattached the macula.
The patient laid in the office in a face-down position for 30 minutes and was instructed to maintain the face-down position overnight. On the second day, his vision was 20/400 and the optomap revealed that the macula was reattached, and much of the subretinal fluid shifted inferiorly. It was likely he alternated between the face-down and head-up position. Laser retinopexy was performed to seal the horseshoe tear found in the superior temporal quadrant (one day after pneumatic). The patient was then asked to maintain head tilted to left, so that the pneumatic retinopexy would continue to …