Peripheral optical coherence tomography montage guided successful management of retinal detachment with sub retinal bands.

Sub Retinal Bands (SRB) often complicate old Rhegmatogenous Retinal Detachments (RRD). We discuss the utility of Optical Coherence Tomography (OCT) montage in such a case of a 23 year old female who presented with BCVA of 20/40 in OS with a complicated cataract. She was found to have a shallow subtotal RRD in left eye extending till temporal ora serrata with macula off and a SRB extending across the temporal vascular arcades with superotemporal lattice with holes. The RD appeared to be self-settling peripherally due to pigmentary changes. OD was normal.

RRD was imaged with OCT montage. The Neuro Sensory Retinal Detachment (NSD) started from the fovea and involved the immediate periphery with attached extreme periphery (Fig. 1). At the maximal height (583u) of the NSD, a round highly reflective structure was observed below the neuro sensory retina corresponding to the SRB. The holes were treated with cryotherapy and at first month follow-up the height of RD had decreased to 515u being centered at the SRB. 3 months later, the retina had completely attached, and foveal contour attained with a fold over the SRB (Fig. 2). As compared to images at presentation, there was focal pigment deposition in the area of the SRB (Fig. 3).

Figure 1

HDOCT montage of LE showing attached fovea and beginning of RD in temporal macula (white arrowhead), SRB (white arrow), area of maximum height of RD (black arrow) and attached peripheral retina (black arrowhead).

Figure 2

HDOCT montage of LE demonstrating complete retinal attachment and attainment of foveal contour. The SRB (white arrow) can be seen with optical shadow and minimal folding of neurosensory retina.

Figure 3

Fundus photograph montages. (A) Fundus image at presentation showing the partially detached macula (white arrowhead), the sub retinal band (white arrow), shallow retinal detachment in the area of the sub retinal band (black arrow) and peripherally self-settling retinal detachment (black arrowhead). (B) Fundus image at 3 months of follow-up showing completely attached retina. Also note focal deposition of pigment in the area of the sub retinal band (white arrow).

Comment

The montage was created using the fixation light to change patients’ fixation while monitoring the area being scanned as visible on the display. Later these pictures were combined to create a montage (Figure 1, Figure 2).

OCT montage systems have been analyzed and used in cases with retinoschisis and macular holes. Shallow non-resolving localized RD with SRB near macula is a challenging situation especially with good visual acuity. Serial OCT measurement of height of NSD at level of SRB may be used to detect sub clinical SRB contracture and increasing RD for early surgical intervention. Also, peripheral OCT is an objective way to document clinically doubtful sub retinal fluid in shallow RRDs.

OCT based montages can thus help in managing doubtful cases of shallow RRDs.