Loculated subretinal fluid after pneumatic vitreolysis

Abstract

Purpose: To present, to the authors' knowledge, the first reported case of loculated subretinal fluid associated with pneumatic vitreolysis (PVL).

Observations: A 74 year old female was followed for 9 months with vitreomacular traction (VMT) and 20/20 visual acuity in her right eye. Her visual acuity decreased at 9 months to 20/50 and she was treated with PVL. VMT release was successful on day 7. An isolated shallow pocket of loculated subretinal fluid developed inferotemporal to the fovea at one month after PVL and persisted for 14 months. The subretinal fluid eventually resolved at 14 months after PVL, and visual acuity improved to 20/30, and there were no electroretinographic abnormalities.

Conclusion and importance: Localized subretinal fluid is an unusual complication of PVL. No adverse visual outcome developed despite the persistent extrafoveal subretinal fluid in this case, and the subretinal fluid eventually resolved over a year after PVL.

Keywords: Pneumatic vitreolysis; Posterior vitreous detachment; Subretinal fluid; Vitreomacular traction.

Fig. 1

SD-OCT at 9 months after initial presentation demonstrating symptomatic vitreomacular traction (VMT); visual acuity was decreased to 20/50.

Fig. 2

SD-OCT at 1 week after pneumatic vitreolysis (PVL) with successful VMT release.

Fig. 3

A. Color fundus photograph at 1 month after PVL demonstrating subtle pocket of subretinal fluid (SRF) inferotemporal to the fovea (inside white arrows), as confirmed by the corresponding SD-OCT in Fig. 3B. There were also subtle outer retinal changes adjacent to the zone of SRF. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

FA demonstrating non-fluorescence at the location of loculated SRF (inside white arrows), although there was darker background fluorescence of the zone of loculated SRF and the adjacent fundus in comparison to the superior fundus.

Fig. 5

SD-OCT at the level of the fovea at 5 months after PVL. The edge of SRF can just be visualized.

Fig. 6

SD-OCT at the level of the fundus inferotemporal to the fovea demonstrating persistent localized SRF at 5 months after PVL. However, there were outer retinal ripples and ellipsoid changes, suggestive of resolving SRF.

Fig. 7

SD-OCT obtained at 14 months after PVL showed spontaneous resolution of all subretinal fluid with partial thinning of the outer retinal layer, and visual acuity was further improved to 20/30.