Surgical Repair of a Persistent Full-Thickness Macular Fold With Base-to-Base Photoreceptor Apposition Secondary to Hypotony From Trabeculectomy Surgery and Postoperative Laser Suturelysis

Abstract

Purpose: To report the successful repair of a persistent full-thickness retinal fold secondary to hypotony from trabeculectomy surgery. Results: Laser suturelysis was performed on a patient to relieve an elevated intraocular pressure posttrabeculectomy surgery. This resulted in chronic hypotony, a full-thickness retinal fold, and a decline in visual acuity to “count fingers.” The patient underwent a pars plana vitrectomy with internal limiting membrane peeling, subretinal injection of balanced saline solution, fluid-air exchange, injection of F-Decalin, peripheral retinotomy, endolaser photocoagulation, and vitreous substitution with 15% C3F8 gas. Anatomic improvement was documented via multimodal imaging. Six months postoperatively best-corrected visual acuity (BCVA) returned to 20/30. Conclusions: We describe a surgical approach to full-thickness retinal folds and review the management options previously reported in the setting of hypotony. We provide support for the active management of appositional full-thickness retinal folds involving the fovea and demonstrate that surgical correction can significantly improve BCVA even after 4 months of hypotony.