Spontaneous Breakaway of Tractional Flap Tear during Acute Posterior Vitreous Detachment after Laser Retinopexy

Flap tears in the peripheral retina are the most dangerous for the occurrence of regmatogenous retinal detachment (61–83 %), as they are always the result of dynamic vitreoretinal traction. The main method of preventing of regmatogenous retinal detachment in patients with flap tears is laser treatment. Prophylactic laser retinopexy is performed to create an area of sufficient chorioretinal adhesion completely surrounding the retinal break. Currently, the method of non-contact navigated laser retinopexy is widely used. It is safe and well-tolerated procedure equally effective to traditional laser coagulation. The reason for the progression of retinal detachment, which occurs despite preventive therapy, may be insufficient fusion around the retinal break, or the active traction force during the progression of posterior vitreous detachment (PVD). The method of flap retinotomy using modern YAG laser systems with coaxial illumination have been reported in the literature, but there are no publications on spontaneous breakaway of tractional flap tear during acute PVD progression. The case of spontaneous breakaway of tractional flap tear during acute posterior vitreous detachment after laser retinopexy is presented. A 55-year-old woman complained of floaters and photopsias in her left eye within a day. Multimodal examination was performed: visometry, perimetry, scanning laser ophthalmoscopy, ultrasound B-scanning, optical coherence tomography of the retina, fundus photoregistration. Laser treatment was performed with the Navilas Laser System 577s using the non-contact ncPRP lens.

Results: The examination revealed a flap tear in the upper nasal segment with subretinal fluid around and spot hemorrhage. Preventive non-contact laser coagulation of the retina was performed in six rows together along the entire border of the tear. 11 days after the operation, the patient applied again with complaints of increased photopsias within a day. During the examination, spontaneous breakaway of the flap from the base, complete retinal attachment, absence of intraocular hemorrhage were revealed.

Conclusion: Timely diagnosis and preventive laser retinopexy of peripheral retinal flap tear contributed to the prevention of development of the rhegmatogenous retinal detachment 

1. Brod R.D., Lightman D.A., Packer A.J., Saras H.P. Correlation between vitreous pigment granules and retinal breaks in eyes with acute posterior vitreous detachment. Ophthalmology. 1991;98(9):1366–1369. DOI: 10.1016/s01616420(91)321249

2. Dayan M.R., Jayamanne D.G., Andrews R.M., Griffiths P.G. Flashes and floaters as predictors of vitreoretinal pathology: is followup necessary for posterior vitreous detachment? Eye (Lond). 1996;10 (Pt 4):456–458. DOI: 10.1038/eye.1996.100

3. Coffee R.E., Westfall A.C., Davis G.H., Mieler W.F., Holz E.R. Symptomatic posterior vitreous detachment and the incidence of delayed retinal breaks: case series and meta-analysis. Am J Ophthalmol. 2007;144(3):409–413. DOI: 10.1016/j.ajo.2007.05.002

4. Blindbaek S., Grauslund J. Prophylactic treatment of retinal breaks — a systematic review. Acta Ophthalmologica. 2015:93(1):3–8. DOI: 10.1111/aos.12447

5. van Overdam K.A., BettinkRemeijer M.W., Klaver C.C., Mulder P.G., Moll A.C., van Meurs J.C. Symptoms and findings predictive for the development of new retinal breaks. Arch Ophthalmol. 2005;123(4):479–484. DOI: 10.1001/archopht.123.4.479

6. Carrero J.L., PerezFlores I., Cid Galano M., FernandezFernandez M., Heras-Raposo F., Vazquez-Nuñez R., Lopez-Fuentes M. BScan Ultrasonography to screen for retinal tears in acute symptomatic agerelated posterior vitreous detachment. Ophthalmology. 2009;116(1):94–99. DOI: 10.1016/j.ophtha.2008.08.040

7. Byer N.E. Natural history of posterior vitreous detachment with early manage ment as the premier line of defense against retinal detachment. Ophthalmology. 1994(9);101:1503–1514. DOI: 10.1016/s01616420(94)311419

8. Doga A.V., Kryl L.A., Yanilkina Yu.E. Laser surgery in the treatment of retinal breaks Tambov University Reports. Series Natural and Technical Sciences = Vestnik Tambovskogo Universiteta. 2016;21(4):1500–1504 (In Russ.). DOI: 10.20310/18100198201621415001504

9. Doga A.V., Volodin P.L., Kryl L.A., Yanilkina Y.E., Buryakov D.A. Laser retinotomy with “ultra q reflex” system for the prevention of rhegmatogenous retinal detachment due to the peripheral horseshoe tears Ophthalmology in Russia = Oftal’mologiya. 2018;15(1):24–31 (In Russ.). DOI: 10.18008/18165095201812431

10. Shaimova V.A., Shaimov T.B., Shaimov R.B., Boĭko É.V., Zarezina A.S., Kravchenko T.G., Galin A.Iu., Kuchkildina S.Kh., Shaimova T.A., Aksenfeld G.V., Fomin A.V. Preventive laser treatment of tractional symptomatic retinal flap tears: longterm outcomes. Annals of Ophthalmology = Vestnik Oftalmologii. 2020;136(3):32–38 (In Russ.). DOI: 10.17116/oftalma202013603132

11. Shaimova V.A., Shaimov T.B., Kulikov A.N., Shaimov R.B., Maltsev D.S., Zarezina A.S., Kravchenko T.G., Galin A.Y., Islamova G.R., Malinovs kaya M.A., Dmukh T.S., Kuchkildina S.K., Titova S.V., Panin M.A. Noncontact navigated laser retinopexy for peripheral retinal tears and rhegmatogenous de generations: first experience. Annals of Ophthalmology = Vestnik Oftalmologii. 2021;137(1):46–52 (In Russ.). DOI: 10.17116/oftalma202113701146

12. Silva R.A., Blumenkranz M.S. Prophylaxis for Retinal Detachments [site]. American Academy of Ophthalmology. October 29, 2013. Accessed April 29, 2022. http://www.aao.org/munnerlynlasersurgerycenter/prophylaxisretinaldetachments

13. Wilkinson C.P. Interventions for asymptomatic retinal breaks and lattice de generation for preventing retinal detachment. Cochrane Database Syst Rev. 2014(9):CD003170. DOI: 10.1002/14651858.CD003170.pub4

14. Brinton D.A., Willkinson C.P. Retinal Detachment: Principles and Practice,3d ed. Oxford: University Press in cooperation with American Acadamy of Ophthalmology, 2009. 258 p.

15. L`Esperance F.A. Jr. Ophthalmic Lasers. Photocoagulation, Photoradiation and Surgery. St. Louis: Mosby; 1983. 606 p.