ABSTRACT
PURPOSE: To report a case of anatomic closure and functional improvement in a patient affected by refractory full-thickness macular hole (FTMH) undergone a combined 41-gauge (g) surgically induced macular detachment and free internal limiting membrane (ILM) flap technique. METHODS: This is a retrospective case-report of a 70-years-olded woman affected by refractory FTMH who referred to Ophthalmology Unit of Guglielmo da Saliceto Hospital, Piacenza (Italy) in April 2023. The patient underwent a combined 41-g surgically induced macular detachment and free ILM flap. Macular detachment was induced by multiple subretinal injections of balanced salt solution (BSS) by 41-g needle through three retinotomies. Spectral-domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) were performed preoperatively and postoperatively at 7th day, 1st and 6th month. RESULTS: On 7th postoperative day, FTMH showed complete closure. BCVA improved from preoperative 20/400 to 20/70 at 6th postoperative month. DISCUSSION: BSS subretinal injection allowed the mobilization and relaxation of retina at the posterior pole. Although the edges of the hole were still detectable, their diameters were inferior to preoperative measurements. Autologous free ILM flap allowed to fill the residual gap into the hole. CONCLUSION: The final anatomic closure, and the postoperative functional improvement demonstrated the effectiveness of this approach, supporting its indication for refractory FTHM.
ABSTRACT
CASE REPORT: A 27-year-old white man with a 5-year history of pigment dispersion syndrome presented for evaluation. His past ocular history was significant for bilateral intraocular pressure elevation that had required intraocular pressure -lowering medication (beta-blocker-prostaglandin analogue fixed combination). On ophthalmic examination, the visual acuity was 20/20 without correction in both eyes. Anterior chamber slit-lamp examination revealed a pigmented round mass with modest transillumination at 6-o'clock position of the right eye. When asked, the patient reported that he had first noticed a shadow in his right eye during childhood when he was flexing his neck and keeping a face-down position for a few seconds. During a head-flexing test, the mass freely floated in the anterior chamber. When the patient extended the neck, the round mass could be seen in front of the pupil. After a few moments, the mass would slowly fall to the iridocorneal angle at the 6-o'clock position. Ultrasound biomicroscopy and anterior-segment optical coherence tomography confirmed that the lesion was a pigmented cyst without internal reflectivity. Specular microscopy examinations, performed to exclude cyst-induced corneal endothelium compromise, revealed a cell-density of ~3000 cells/mm in both eyes. Gonioscopy showed an open angle with trabecular pigmentation and funduscopy a cup-to-disc ratio of 0.5 bilaterally. Visual fields and optical coherence tomography tests were within normal limits. CONCLUSIONS: The etiology of free-floating iris cysts is unclear, but it is generally agreed that these masses are usually dislodged pigment epithelial cysts. This is the first report of a unilateral free-floating iris cyst associated with bilateral pigment dispersion syndrome.
