Dear Editor,

We read with keen interest the article by Atmaca-Sonmez et al on "Persistent detachment of the fovea after non-buckling repair of rhegmatogenous retinal detachment".[1] As stated in the article the presence of persistent detachment of the fovea and localised delayed subretinal fluid absorption (DSRFA) has been noted quite frequently after scleral buckling and pneumatic retinopexy, after the advent of optical coherence tomography (OCT). Wolfensberger concluded that the presence of persistent subretinal fluid was virtually nonexistent after vitrectomy with gas tamponade in his prospective study.[2]

We have seen the presence of localised DSRFA in a 35 year old male who had undergone belt buckling with vitrectomy, endodrainage and silicone oil endotamponade for rhegmatogenous retinal detachment due to a posterior retinal tear in his left eye. This patient had complaints of distortion and defective vision 4 months after surgery. Best-corrected vision was 20/60. On examination the fovea looked normal but multiple small rounded lesions around 1/4th disc areas were seen temporal to the fovea simulating pigment epithelial detachments. OCT (Zeiss Stratus Model 3000) showed multiple areas of localized neurosensory detachment ranging from ¼ to ½ disc area in the area of previous retinal detachment. The fovea also showed the presence of localized sub retinal fluid (SRF).

This instance shows that persistent subretinal fluid can occur in the presence of silicone oil also apart from cases of scleral buckling, pneumatic retinopexy and vitrectomy with gas tamponade as earlier reported.

References

1. P Atmaca-Sonmez, M W Johnson, D N Zacks. Persistent detachment of the fovea after non-buckling repair of rhegmatogenous retinal detachment. Br J Ophthalmol 2006; 90: 920 - 1.

2. Wolfensberger TJ. Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery. Ophthalmology 2004;111:1340 - 3.

Figure 1: Fundus image showing the silicone oil reflex (Black arrow) at the fovea and multiple bleb like elevations temporal to it (White arrow)

Figure 2: OCT pictures showing the persistant subfoveal fluid (Green arrow) and loculated neurosensory detachments (Red arrows)