Circumscribed retinal detachment after radial optic neurotomy for central retinal vein occlusion

It has been suggested that radial optic neurotomy (RON) may improve the functional outcome of retinal vein occlusions. We report the case of a patient presenting with a high, but circumscribed, peripapillary retinal detachment following RON for central retinal vein occlusion. A 69-year-old man presented with a high retinal detachment 2.5 years after RON for central retinal vein occlusion. It was complicated by a recurring cystoid macular edema; however, best visual acuity was 0.5. The retinal detachment developed slowly. Its location was nasal and superior to the optic disc. It did not extend beyond the equator and had no detectable retinal break. The retinal detachment was successfully treated by an encircling band, pars plana vitrectomy, laser coagulation, and air endotamponade. There was no obvious persisting retinal defect at the RON site. Although other mechanisms should be taken into account, this case indicates that it might be possible to create a fistula between the subarachnoid and subretinal space, leading to a slowly developing retinal detachment. A similar case report pointed out that special attention should be paid to the depth of the radial incision into the optic nerve head.