JOSR: Journal of Social Research

November 2022, 1 (12), 475-484

p-ISSN: 2827-9832 e-ISSN: xxxx-xxxx

Available online at http:// https://ijsr.internationaljournallabs.com/index.php/ijsr

http://ijsr.internationaljournallabs.com/index.php/ijsr

RHEGMATOGENOUS RETINAL DETACHMENT IN HIGH

MYOPIA

Priscilla Christina Natan

, Putu Budhiastra

, Ari Andayani

, Komang Putra

Tridiyoga

General Practitioner, Balimed Hospital Denpasar

, Bali Ophthalmologist, Balimed

Hospital Denpasar

, Bali Ophthalmologist, Ramata Eye Hospital

Denpasar3

, Bali

Ophthalmologist, Balimed Hospital Denpasar, Bali

priscillanatan@gmail.com

Abstrak (indonesia)

Received:

Revised :

Accepted:

20 Oktober

2022

25 Oktober 2022

30 Oktober 2022

Latar Belakang: Miopia tinggi berhubungan dengan

pemanjangan bola mata, dan pemanjangan bola mata

yang berlebihan dapat menyebabkan peregangan

mekanis dan penipisan lapisan koroid dan epitel

pigmen retina (RPE), sehingga menyebabkan

berbagai perubahan degeneratif retina, salah satunya

adalah ablasi retina. Ablasio retina adalah suatu

kondisi ketika retina neurosensori terlepas dari RPE

dengan miopia tinggi sebagai salah satu faktor

risikonya.

Tujuan: Melaporkan kasus ablasio retina

regmatogenosa dan robekan retina multipel pada

pasien miopia tinggi. Melaporkan kasus ablasio retina

regmatogenosa dan robekan retina multipel pada

pasien miopia tinggi.

Metode: Seorang wanita berusia 45 tahun datang ke

Rumah Sakit Balimed dengan pandangan kabur

mendadak pada mata kiri, ketajaman penglihatan

menghitung jari (3/60) dan riwayat miopia tinggi

pada kedua mata. Mata kanan S-9.00 dan Mata kiri S-

6.00. Pada pemeriksaan oftalmologi ditemukan ablasi

retina dan robekan retina multiple pada mata kiri. Dia

dirujuk ke Rumah Sakit Mata Ramata Denpasar, dan

menjalani pars plana vitrectomy (PPV) dengan injeksi

gas C3F8 intravitreal dan endolaser (EL) untuk

robekan retina multipel pada mata kiri sekitar 2

minggu kemudian (12 September 2022). Satu bulan

setelah vitrektomi, tekanan intraokular normal.

Priscilla Christina Natan

, Putu Budhiastra

, Ari Andayani

, Komang Putra Tridiyoga

JOSR: Journal of Social Research, 1(12), 475-484

Rhegmatogenous Retinal Detachment In High Myopia 476

Operasi berhasil dilakukan dan pada kunjungan

tindak lanjut tampak retina menempel dan terdapat

peningkatan tajam penglihatan yaitu 6/38 pada mata

kiri.

Hasil: Miopia tinggi merupakan salah satu faktor

terbesar terjadinya ablasio retina. Penatalaksanaan

ablasi retina bervariasi tergantung pada area ablasi,

usia pasien, presentasi klinis dan temuan sistemik

lainnya.

Kesimpulan: Ablasio retina regmatogenosa

merupakan tipe ablasio retina yang paling sering

terjadi yang terutama disebabkan oleh miopia tinggi.

RD adalah keadaan ablasi neurosensori retina dari

RPE dengan miopia tinggi sebagai faktor risiko.

Penatalaksanaan RRD dapat mencakup scleral buckle

atau Pars Plana Vitrectomy. Dalam kasus ini,

dilaporkan bahwa RRD dengan pengobatan segera

dengan PPV menghasilkan peningkatan ketajaman

visual yang baik.

Kata kunci: Ablasi Retina; Rhegmatogenous;

Miopia Tinggi

Abstract (English)

Background: High myopia is associated with

elongation of the eyeball, and excessive elongation

of the eyeball can cause mechanical stretching and

thinning of the choroid layer and retinal pigment

epithelium (RPE), causing various degenerative

changes of the retina, one of which is retinal

detachment. Retinal detachment is a condition when

the neurosensory retina detaches from the RPE with

high myopia as a risk factor.

Objective: Reported a case of rhegmatogenous

retinal detachment and multiple retinal tears in a

high myopia patient. Reported a case of

rhegmatogenous retinal detachment and multiple

retinal tears in a high myopia patient.

Methods: A 45-year-old woman came to Balimed

Hospital with sudden blurring of vision in her left

Priscilla Christina Natan

, Putu Budhiastra

, Ari Andayani

, Komang Putra Tridiyoga

JOSR: Journal of Social Research, 1(12), 475-484

Rhegmatogenous Retinal Detachment In High Myopia 477

eye, visual acuity on counting fingers (3/60) and a

history of high myopia in both eyes. Right eye S-9.00

and left eye S-6.00. On ophthalmologic examination,

retinal detachment and multiple retinal tears were

found in the left eye. He was referred to Ramata Eye

Hospital Denpasar, and underwent pars plana

vitrectomy (PPV) with intravitreal injection of C3F8

gas and endolaser (EL) for multiple retinal tears in

the left eye approximately 2 weeks later (12

September 2022). One month after vitrectomy,

intraocular pressure was normal. The operation was

successful and at the follow-up visit the retina was

attached and there was an increase in visual acuity

of 6/38 in the left eye.

Results: High myopia is one of the biggest factors

for retinal detachment. Management of retinal

detachment varies depending on the area of

detachment, patient age, clinical presentation and

other systemic findings.

Conslusion: Rhegmatogenous retinal detachment is

the most common type of retinal detachment caused

mainly by high myopia. RD is a state of retinal

neurosensory detachment from RPE with high

myopia as a risk factor. Management of RRD may

include a scleral buckle or pars plana vitrectomy. In

this case, it was reported that RRD with prompt

treatment with PPV resulted in a good improvement

in visual acuity.

Keywords: Retinal detachment; Rhegmatogenous;

High Myopia

*Correspondent Author : Priscilla Christina Natan

Email : priscillanatan@gmail.com

BACKGROUND

High myopia or pathological myopia is associated with globe elongation

and a refractive error of at least 6 diopters (D) and/or axial length of greater than

25.5 mm. The prevalence of high myopia varies considerably in different ethnic

groups and has been estimated to be around 10% in Asian populations. Excessive

axial elongation of the globe can caused mechanical stretching and thinning of the

Priscilla Christina Natan

, Putu Budhiastra

, Ari Andayani

, Komang Putra Tridiyoga

JOSR: Journal of Social Research, 1(12), 475-484

Rhegmatogenous Retinal Detachment In High Myopia 478

choroid and retinal pigment epithelium (RPE) layers, resulting in various retinal

degenerative changes, such as retinal detachment (Kreissig, 2005). Retinal

detachment caused by high myopia can be repaired by pneumatic retinopexy,

placement of a scleral buckle to hold the retina to the eye, or repaired by pars

plana vitrectomy and replaced with silicone gel after the retina is reattached with

laser. Although the success rate of reattachment of retina is much higher with the

modern techniques of pars plana vitrectomy and internal tamponades,

conventional scleral buckling is still considered to be a safe and effective

technique in the primary management of uncomplicated rhegmatogenous retinal

detachment (Khan, Jan, Karim, Iqbal, & Saeed, 2010).

RESEARCH METHODS

A 45 years old woman came to the Balimed Hospital on August 30

2022, with the chief complaint of sudden blurry vision on the left eye, with finger

counting visual acuity and history of high myopia in both eyes. Right eye S-9.00

and Left eye S-6.00. On ophthalmological examination on August 30

2022

found that the visual acuity 6/9.5 of the right eye and 3/60 on the left eye (Sung,

Lee, Won, Lim, & Kim, 2020). Orthotropia eyeball position, no movement

restriction in all directions. The intraocular pressure (IOP) was 11 mmHg and the

left eye was 12 mmHg. Examination of the anterior segment of the right eye was

within normal limits. An examination of the anterior segment of the left eye

revealed cornea with a pigment iris, irregular pupil, posterior synechia, and

slightly cloudy lens. On the posterior segment, there is a retinal detachment

multiple retinal tears on the left eye (Henry, Covert, Han, Sanchez, & Bhatia,

2010).

The patient was diagnosed with rhegmatogenous retinal detachment

(RRD) LE + high myopia both eyes (Tetsumoto et al., 2020). She was referred to

Ramata Eye Hospital Denpasar, and underwent a pars plana vitrectomy (PPV)

with intravitreal C3F8 gas injection and endolaser (EL) for multiple retinal tears

on the left eye around 2 weeks later (September 12

2022) (Hakin, Lavin, &

Leaver, 1993).

Priscilla Christina Natan

, Putu Budhiastra

, Ari Andayani

, Komang Putra Tridiyoga

JOSR: Journal of Social Research, 1(12), 475-484

Rhegmatogenous Retinal Detachment In High Myopia 479

Figure 1. The results of Fundus Photo and Optical Coherence Tomography (OCT)

on Left Eye on August 30

2022 shows the rhegmatogenous retinal detachment on

superior retina

One day after the operation on August 31

2022, ophthalmological

examination revealed IOP RE 11 LE 12. The anterior segment RE is within

normal limit, cornea is clear, isocor pupil, and the lens is slightly cloudy, the

posterior segment of the left eye has the retina completely attached. The patient

received 2x500 mg ciprofloxacin tablets, levofloxacin eye drops 6 times/day LE,

prednisolone acetate eye drops 6 times/day LE, and paracetamol tablets 3x500

mg orally (Hwang, 2012). One week postoperative follow up visit showed light

perception on the right eye and hand movement on the left eye, IOP RE 12 and

in RE 14 (Jackson, Donachie, & Johnston, 2016). Examination of anterior

segment of right eye and left eye was still the same as day one postoperative.

The patient was then advised to follow up visit two weeks later and received eye

drop therapy of prednisolone acetate 5 times/day LE with weekly tapering off

and levofloxacin 6 times/day LE (Soni, Hainsworth, & Almony, 2013). One

month after the pars plana vitrectomy, the intraocular pressure is normal. The

operation was successfully performed and on the follow up visit the retina

appeared attached and there is an improvement of visual acuity is 6/38 on the

left eyea (Bourla, Bor, Axer-Siegel, Mimouni, & Weinberger, 2010).

RESULTS AND DISCUSSION

People with high myopia are prone to retinal detachment. A detach retina

needs immediate diagnosis and treatment to prevent vision loss (Park et al., 2015).

Myopia is caused by an eyeball that’s longer than normal. Because the eyeball is

longer, it pulls on the retina and is prone to pulling a piece of retina off the back

of the eye wall (Heussen et al., 2011). The retina is also thinner overall in myopic

people and more prone to developing small holes or tears (Campo et al., 1999).

Priscilla Christina Natan

, Putu Budhiastra

, Ari Andayani

, Komang Putra Tridiyoga

JOSR: Journal of Social Research, 1(12), 475-484

Rhegmatogenous Retinal Detachment In High Myopia 480

People with myopia -1 to -3 diopters have a risk four times as high as the

general population of RD, while people whose refractive error is higher

than -3 diopters have a tenfold risk. The risk of RD in high myopes (people with a

-6.00 or higher diopter) is 5% per year. A study reported in the American Journal

of Epidemiology suggests that 55% of all RDs are caused by myopia (Sharma,

Grigoropoulos, & Williamson, 2004).

Retinal detachment is divided into two major groups, in the presence of

traction and in the absence of traction. The most common type of retinal

detachment is rhegmatogenous retinal detachment (RRD) which occurs due to the

entry of fluid from the vitreous cavity into the potential space between the

neurosensory retina and the retinal pigment epithelium (RPE) through full

thickness breaks or holes (Alexander, Ang, Poulson, & Snead, 2008). The most

common tear is a horseshoe tear that occurs in sites with large vitreoretinal

adhesions, generally occurring at the posterior border of the vitreous base in the

posterior vitreous detachment (PVD) (Chan, Lin, Nuthi, & Salib, 2008). The

characteristics of RRD include the mobility disorder of the liquefied vitreous gel,

the traction force that can cause a break in the retina, a retinal break that can be

passed through the liquefied vitreous into the subretinal space. RRDs that occur

posterior to the equator are a feature of RRD resulting from high myopia. Risk

factors for RRD include high myopia, family history of RRD, history of contra-

lateral eye tears or detachments, recent vitreous detachment, and trauma. The

patient in this case report had RRD with risk factors of high myopia, the patient

had a history of correction of vision with S-9.00 RE, and -6.00 LE, but the patient

was using S-6.00 on both eyes for her convenience (Thompson, 1989).

Rhegmatogenous retinal detachment (RRD) is a severe vision-threatening

condition (Wong & Thompson, 1988). Current treatment modalities for RRD

include pars plana vitrectomy (PPV) and scleral buckling. Notably, PPV with a

wide-angle viewing system has been gaining popularity as the first-line therapy,

primarily because of its low invasiveness. Self-sealing small incisions lead to less

surgical trauma, postoperative inflammation, and postoperative astigmatism,

resulting in better postoperative comfort for patients and an earlier visual

recovery.

10-22

However, disadvantages of PPV for RRD include postoperative

visual disturbance and limitations in day-to-day activities for an extended period,

due to gas tamponade within the vitreous cavity.

Typically, sulfur hexafluoride

(SF6), octafluoropropane (C3F8), and room air are used as postoperative

tamponade materials to seal causal retinal breaks; 20% SF6 lasts for ~2 weeks,

23-25

while 13% C3F8 lasts for ~2 months

23,24

in the vitreous cavity. In comparison to

these materials, room air has a shorter absorption time (Fineberg et al., 1975).

Therefore, room air may be usefulfor reducing the disadvantages of PPV listed

Priscilla Christina Natan

, Putu Budhiastra

, Ari Andayani

, Komang Putra Tridiyoga

JOSR: Journal of Social Research, 1(12), 475-484

Rhegmatogenous Retinal Detachment In High Myopia 481

above. In addition, tamponade with room air has a lower probability of increased

intraocular pressure and a reduced possibility of concurrent cataracts compared to

long-acting gases (LAGs), such as SF6 and C3F8 (Ji, Rong, & Lu, 2018).

Pneumatic retinopexy and scleral buckle are the initial treatment options

for patients with localized one-quadrant detachment (Esteban, Mateo, Casas, Lara,

& Ascaso, 2021). Young patients with a hole in the anterior are advised to

undergo a scleral buckle procedure.

PPV is indicated in patients with a large,

bullous retinal detachment, and in elderly patients with a liquefied vitreous.

Retinal detachments with multiple quadrant breaks, or patients with invisible

breaks, or pseudophakic patients are also good candidates for PPV. Vitreous

liquefaction occurs naturally due to aging, but can occur more rapidly in high

myopia, surgical or non-surgical trauma, and in intraocular inflammation. In this

patient, PPV was performed considering that vitreous liquefaction had occured

due to high myopia and the presence of intraocular inflammation (Rey et al.,

2018).

Pars plana vitrectomy (PPV) is a commonly employed technique in

vitreoretinal surgery that enables access to the posterior segment for treating

conditions such as retinal detachments, vitreous hemorrhage, endophthalmitis, and

macular holes in a controlled, closed system. The procedure derives its name from

the fact that vitreous is removed (i.e. vitreous + ectomy = removal of vitreous) and

the instruments are introduced into the eye through the pars plana.

Patients with RRD may present with floaters, photopsia, and/or a “curtain”

defect that obscures part of the visual field. Visual acuity (VA) ranges from

excellent to poor, depending on whether the macula is still attached. In patients

with macula-off RRD, vision usually is decreased. If the area of detachment is

large, an afferent pupillary defect may be present. Intraocular pressure (IOP) can

be low or high. Low IOP results from increased outflow of intraocular fluid

through the subretinal space and peripapillary connective tissue, particularly if the

optic disc border is involved. High IOP may occur with chronic RRD, in which

photoreceptor outer segments transgress into the anterior chamber and trabecular

meshwork, impeding aqueous outflow.

7,8

Up to 90 % of retinal detachments can be successfully re-attached.

According to Prevent Blindness America. 40% of people after retinal re-

attachment have excellent vision;the other 60% will have some vision loss. 85%

percent of cases will be successfully treated with one operation with the

remaining 15 percent requiring 2 or more operations. After treatment patients

gradually regain their vision over a period of a few weeks, although the visual

acuity may not be as good as it was prior to the detachment, particularly if the

Priscilla Christina Natan

, Putu Budhiastra

, Ari Andayani

, Komang Putra Tridiyoga

JOSR: Journal of Social Research, 1(12), 475-484

Rhegmatogenous Retinal Detachment In High Myopia 482

macula was involved in the area of the detachment. However, if left untreated,

total blindness could occur in a matter of days.

5,6

One of the most serious complications often occurs after pars vitrectomy

surgery plana is cataract, where in 12.5%-80% of post vitrectomy patients have

cataracts within 48 months. The most common type of cataracts are posterior

subcapsular cataract and nuclear sclerotic cataract. Pathophysiology of cataract

formation after vitrectomy still not known for certain, however several factors are

believed to play a role in post-cataract formation after vitrectomy, including the

age of the patient, history of nuclear sclerosis, duration of action vitrectomy,

composition of infusion fluids drained into the vitreous cavity or cannula, diabetic

retinopathy, extensive damage occurs while the action is taking place, injury to

the lens during vitrectomy in progress, light toxicity, disposal and vitreous gel

replacement, and use of gas or silicone oil intraocular.

26-28

CONCLUSION

Rhegmatogenous retinal detachment is a the most common type of retinal

detachment which mainly caused by high myopia. RD is a state of retinal

neurosensory detachment from RPE with high myopia as a risk factor.

Management of RRD can include scleral buckle or Pars Plana Vitrectomy. In this

case, it is reported that RRD with immediate treatment with PPV produce a

favorable visual acuity improvement.

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Priscilla Christina Natan

, Putu Budhiastra

, Ari Andayani

, Komang Putra Tridiyoga

JOSR: Journal of Social Research, 1(12), 475-484

Rhegmatogenous Retinal Detachment In High Myopia 484

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