Successful scleral buckling of late-onset visual decrease in eye with retinal folds

To describe the outcome of scleral buckling to treat radial retinal folds (RFs) that caused a late-onset and sudden visual decrease with impairment of the fovea.

This is an observational case report. Ophthalmic examinations were performed preoperatively and postoperatively and included measurement of the best-corrected visual acuity (BCVA), fundus examination, fluorescein angiography, focal macular electroretinography (FM-ERG), and spectral-domain optical coherence tomography (OCT).

A patient, whose case was reported previously, had a superonasal retinal detachment with a dislocated fovea and good BCVA in her right eye and a sustained BCVA of 40/50 by age 17 years and 3 months. The BCVA decreased suddenly to 20/200 at age 17 years and 11 months. Fundus examinations showed micro-dislocation of the fovea to the RFs and narrowing of the RFs compared with the previous report. FM-ERG showed an almost extinguished response, and OCT images showed abnormalities of the outer nuclear and photoreceptor layers. Encircling and radial scleral buckling was performed. Four months postoperatively, the BCVA improved to 30/50, which corresponded to the recovery of the FM-ERG response and findings on the OCT images. One year and 3 months postoperatively, the BCVA recovered to 35/50 with repositioning of the fovea.

Simultaneous encircling and radial scleral buckling resulted in the recovery of both retinal function and structure in the current case and is a useful surgical option to treat late-onset progressive RFs due to intensification of traction.