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Real-Time Resolution of Bacillary Layer Detachment in Rhegmatogenous Retinal Detachment Following Pneumatic
Miguel Cruz-Pimentel1,2, Sueellen Demian1,2, Tomás Minelli1,2
1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada .
Retinal Cases & Brief Reports
|July 16, 2026
Summary
This case report details the hourly recovery of a bacillary layer detachment (BALAD) in a patient with fovea-off rhegmatogenous retinal detachment (RRD). Prompt treatment led to significant foveal structural recovery and improved vision.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Surgical Techniques
Background:
- Rhegmatogenous retinal detachment (RRD) can lead to significant vision loss, especially when involving the fovea.
- Bacillary layer detachment (BALAD) is a specific finding in RRD that requires careful management.
- Early recognition and intervention are crucial for preserving foveal function.
Purpose of the Study:
- To document the hourly in vivo resolution of a foveal bacillary layer detachment (BALAD) with an intact anterior wall in a patient with fovea-off rhegmatogenous retinal detachment (RRD).
- To illustrate the structural recovery of the fovea using high-resolution imaging after pneumatic retinopexy.
Main Methods:
- A case report of a 58-year-old female patient with fovea-off RRD and foveal BALAD.
- Treatment involved pneumatic retinopexy with anterior chamber paracentesis and intravitreal sulfur hexafluoride gas injection.
- Hourly swept-source optical coherence tomography (SS-OCT) imaging was used to monitor foveal recovery.
Main Results:
- The patient presented with severe visual impairment (counting fingers at 3 feet).
- Following pneumatic retinopexy and face-down positioning, hourly SS-OCT showed excellent structural recovery of the fovea.
- At one month, the retina was attached with visual acuity of 20/100, improving to 20/30 at two months with significant outer retinal band recovery.
Conclusions:
- Recognizing fovea-off RRD with BALAD and an intact anterior wall is critical.
- Urgent intervention can facilitate foveal structural recovery.
- Timely treatment may prevent the progression to BALAD-lamellar hole and full-thickness macular hole.
