Fibrin-glue-assisted retinopexy for coloboma-associated retinal detachment

Background:Retinal detachment (RD) is common (23%-40%) in eyes with uveal coloboma due to early vitreous syneresis, inherent defects at the locus minoris resistentiae, and breaks in intercalary membrane (ICM).[1] Managing eyes with coloboma RD is difficult due to complexity of accessing and repairing retinal breaks. In RD surgeries, tamponade agents are used to provide surface tension across retinal breaks to prevent further fluid flow into the subretinal space until the effect of retinopexy is permanent. According to Tyagi et al., fibrin glue-assisted retinopexy for rhegmatogenous retinal detachment after pars plana vitrectomy is a promising technique that allows early visual recovery and obviates the need for postoperative positioning.[2] Fibrin glue, being an inert substance, usually stays for 1-2 weeks, making it an ideal temporary tamponade to plug the retinal break until the retinopexy effect becomes permanent.Purpose:To assess the role of fibrin-glue-assisted retinopexy in coloboma-associated RD.Synopsis:A male child presented with sudden diminution of vision in the left eye 5 days after trauma. His visual acuity was limited to counting fingers close to face. On examination, a type 3 coloboma with total rhegmatogenous RD and detached ICM was observed. A standard three-port 23G vitrectomy was performed, followed by a core vitrectomy. Triamcinolone-assisted posterior vitreous detachment was initiated, followed by the completion of peripheral vitrectomy. As no obvious retinal breaks were noted, subretinal injection of brilliant blue dye was used to locate the break within the coloboma using the dye extrusion technique. After fluid-air exchange, the dye was observed extruding into the vitreous cavity, thereby confirming the break within the coloboma. Laser retinopexy was done around edges of the coloboma in a continuous mode. Fibrin glue was injected over the site of the break and left for 1 min until a thick coagulum was formed, thereby plugging the retinal break. During the postoperative period, positioning was not advised. On day 5, best corrected visual acuity (BCVA) improved to 20/320 with an attached retina. At the last follow-up, the retina remained attached, and BCVA was 20/50.Highlights:In this interesting case, we illustrate a unique method of plugging the retinal break for coloboma-associated RD using fibrin glue, thereby obviating the need for long-term tamponade and positioning, especially in pediatric patients.Video link:https://youtu.be/M4yu_6aZ_R0