A 40 year-old healthy woman applied to the outpatient clinic with 2-day history of photopsia and floaters in her left eye. The BCVAs were 20/20 for both eyes and the IOPs were within normal limits. Anterior segment examinations of both eyes were also unremarkable.
Ultra wide-field fundus image of the left eye demonstrated 3-retinal breaks at the inferior temporal quadrant (in the box) with weiss ring indicating the posterior vitreous detachment from the optic nerve (arrow).
The patient was treated with argon laser photocoagulation surrounding the retinal break with three rows of confluent white laser burns using a SuperQuad contact lens system (Duration: 0.1 sc, Spot size: 300 micron, Power: 400 mW).
While asymptomatic retinal breaks have a very low risk for retinal detachment; retinal breaks associated with symptoms such as floater and/or photopsia occurring in the setting of acute posterior vitreous detachment are more likely to cause rhegmatogenous retinal detachment. It is known that a retinal break is present in up to 20 percent of acute, symptomatic acute posterior vitreous detachment. Moreover, a weiss ring, defined as peripapillary glial tissue suspended in the vitreous cortex, is present in about half of symptomatic posterior vitreous detachment with an associated retinal break. Untreated, symptomatic horseshoe breaks are reported to lead to rhegmatogenous retinal detachment in 30 to 50 percent of cases. Therefore, acute-onset, symptomatic breaks are generally treated with retinopexy by cryotherapy or laser photocoagulation, in an effort to reduce the risk of progression to retinal detachment.
Credit: Kemal Tekin, M.D., from Ulucanlar Eye Training and Research Hospital
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