Macular hole following conventional repair of bullous retinal detachment using air injection (D-ACE procedure).
OBJECTIVE
Sequential drainage of subretinal fluid (D), injection of air (A), cryotherapy (C), and application of local explants (E) (D-ACE) sequence was introduced in order to overcome the problems encountered in managing superior bullous detachments from multiple large equatorial breaks. The authors recently observed the occurrence of a full-thickness macular hole in one patient developing the day after he underwent a D-ACE procedure.


METHODS
A 61-year-old man presented a bullous retinal detachment in the right eye extending from the 9:30 to the 2 o'clock position, and posteriorly to the vascular arcades two retinal tears were noted, at the equator at 11 o'clock, and anterior to the equator at 12 o'clock. The patient underwent a D-ACE procedure. Subretinal fluid was drained above the lateral rectus muscle at the equator. One and a half milliliters of air were injected 3.5 mm from the limbus midway between the superior and the medial rectus insertions. Cryotherapy was applied to the retinal breaks. A 240 encircling band was used in conjunction with a 276 tyre segment at the level of the tears.


RESULTS
One day after surgery, the retina was flat, but a full-thickness macular hole could be seen with a surrounding cuff of subretinal fluid.


CONCLUSIONS
The mechanisms proposed to explain the occurrence of full-thickness macular holes after D-ACE may involve the concurrence of scleral elongation and vitreofoveal traction by means of previous partial posterior vitreous detachment with persistent posterior attachments at the fovea.
Boscia
F
F
Departments of Ophthalmology and Otorhinolaryngoiatry, University of Bari, Bari - Italy. francescoboscia@hotmail.com
Recchimurzo
N
N
Cardascia
N
N
Sborgia
L
L
Furino
C
C
Sborgia
C
C
D000388:Air; D017679:Cryotherapy; D004322:Drainage / Q000379:methods; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D012163:Retinal Detachment / Q000601:surgery*; D012167:Retinal Perforations / Q000209:etiology*; D012591:Scleral Buckling; D014792:Visual Acuity