CAN PERIPHERAL OPTICAL COHERENCE TOMOGRAPHY B-SCANS INFLUENCE THE SURGEON'S DECISION ON EPISCLERAL SURGERY?

To describe the case of a young boy affected by a rhegmatogenous retinal redetachment in whom the use of peripheral optical coherence tomography led the vitreoretinal surgeon to treat the patient with an additional surgery instead of a "watchful waiting" strategy.

A 13-year-old boy was referred to the Vitreoretinal Department of the study institution affected by a macula-off rhegmatogenous retinal redetachment in his right eye secondary to a second blunt trauma. Three months before, he was treated with episcleral surgery and cryopexy as a result of a first traumatic rhegmatogenous retinal detachment. Once presented to the study Department for a second opinion, a complete ophthalmic examination and optical coherence tomographic scans of the peripheral retina were performed.

Preoperative best-corrected visual acuity was 20/63 (Snellen equivalent). Because the tomographic images clearly showed that the edges of the causative retinal break were not attached to the previous encircling buckle, a second episcleral surgery was performed. Postoperative peripheral optical coherence tomographic B-scans immediately revealed the effective indenting effect of the new scleral buckle, showing a complete reattachment of retinal break's edges. Despite some residual subretinal fluid, best-corrected visual acuity increased to 20/32 after 6 months of the surgery, and no retinal redetachment was observed.

Pre- and postoperative peripheral optical coherence tomography may help the vitreoretinal surgeon to better evaluate the status of the adhesion between the outer retina and the retinal pigment epithelium after episcleral surgery, especially at the level of the retinal tears causing the retinal detachment. This observation could ultimately influence the surgical decision whether to treat if the suspect buckle's malpositioning is also detected on these images.