⚠️ Teaching Case Note: This case has been de-identified and reconstructed for educational purposes. Clinical details reflect real surgical decision-making and outcomes. Patient identity is fully protected.
From “A Black Curtain Over My Eye” to Seeing His Family’s Faces Again
It started without warning. A 58-year-old retired mechanical engineer woke up one morning to find a dark shadow spreading across his left visual field. No pain. No trauma. Just a curtain, slowly closing. Seven days later, when he finally reached Shanghai Eye, Ear, Nose and Throat Hospital, the macula — the central zone responsible for reading, face recognition, and fine detail — had already detached.
He was highly myopic in both eyes. He had undergone cataract surgery in the left eye three years prior. Both factors elevated his retinal detachment risk. Now the clock was running: every additional day of macular detachment reduces the probability of meaningful visual recovery.
Dr. Wang Fenghua’s vitreoretinal team moved immediately.
The Diagnosis: Complex Detachment, Narrow Window
Wide-field fundus photography and B-scan ultrasound confirmed superior quadrant retinal detachment involving the macula. OCT revealed subretinal fluid beneath the fovea, disruption of the ellipsoid zone (EZ line), and subretinal fibrous traction bands. Three retinal breaks were identified: a horseshoe tear at the 2 o’clock position and atrophic holes at 10 and 11 o’clock.
The clinical grade: rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C1 — localized fixed folds and a subretinal membrane. Baseline corrected visual acuity in the left eye: hand motion at 30 cm. Central scotoma and significant distortion on Amsler grid testing. Intraocular pressure normal. Corneal endothelial cell density intact.
The multidisciplinary team — vitreoretinal surgery, imaging, optometry, anesthesia, and nursing — assessed the options. Scleral buckling alone carried low anatomical success rates for this configuration. Conventional 20G vitrectomy would achieve the goal but with greater surgical trauma. The consensus: 25G minimally invasive vitrectomy surgery (MIVS) with comprehensive PVR membrane dissection, internal limiting membrane (ILM) peeling, wide-field endolaser, and long-acting tamponade. The priorities: anatomical reattachment first, macular microstructure preservation second, strict post-operative positioning compliance third.
The Surgery: 72 Minutes, Three Ports, Full Reconstruction
Three 25-gauge transconjunctival sclerotomies were placed via the pars plana. Core vitrectomy was performed, followed by induction of posterior vitreous detachment (PVD). Triamcinolone acetonide staining identified residual vitreous cortex, preventing iatrogenic breaks during cortical removal.
PVR membrane dissection followed — the most technically demanding phase. Using bimanual microforceps and membrane hooks, proliferative membranes were peeled layer by layer from the retinal surface and subretinal space. Within a 3-disc-diameter radius of the fovea, ILM peeling was performed under Brilliant Blue G staining, eliminating tangential traction vectors and reducing the risk of post-operative epiretinal membrane recurrence.
All three retinal breaks were precisely localized under wide-angle visualization. Confluent 360° endolaser photocoagulation was applied — spot spacing at half-spot diameter, energy titrated progressively — creating a complete chorioretinal adhesion barrier. Air-fluid exchange evacuated the subretinal fluid. Intraoperative OCT (iOCT) confirmed foveal reattachment and absence of residual traction in real time.
Given the PVR C1 grade and macula-off duration exceeding seven days, 1,000 cSt silicone oil was selected for tamponade — providing durable internal support and reducing early redetachment risk. The 25G self-sealing sclerotomies required no sutures. Anterior chamber reformation completed. Total operative time: 72 minutes. Intraocular pressure stable throughout. No active intraoperative bleeding.
Recovery: Positioning, Patience, and Restored Vision
At 24 hours post-operatively, intraocular pressure measured 18 mmHg. The silicone oil bubble was well-positioned. Strict face-down or lateral decubitus positioning — at least 16 hours per day — was initiated immediately. Topical corticosteroids, antibiotics, and prophylactic IOP-lowering drops were prescribed.
At one week, fundus examination confirmed full-thickness retinal reattachment with no macular re-detachment. OCT showed partial restoration of the EZ line and a 30% reduction in central foveal thickness.
At three months, planned silicone oil removal was performed via 25G microsurgery. Intraoperative inspection confirmed retinal stability and no new PVR formation. Air tamponade replaced the oil and was absorbed within 24 hours.
At six months: corrected visual acuity had recovered to 0.5 (20/40). Amsler grid distortion was significantly reduced. OCT showed stable outer nuclear layer thickness and near-normal foveal contour. He had resumed daily reading, blueprint review, and moderate outdoor activity.
His own words: “From a black curtain falling over my eye, to seeing my family’s faces clearly again — the microsurgery and the weeks of face-down positioning were both essential. One without the other wouldn’t have been enough.”
About Dr. Wang Fenghua
Dr. Wang Fenghua is Director of Vitreoretinal Surgery at Shanghai Eye, Ear, Nose and Throat Hospital, Fudan University. A leading specialist in complex retinal detachment, macular hole repair, and diabetic vitreoretinopathy, she is among China’s most experienced vitreoretinal surgeons, with international fellowship training. Her department handles some of the most technically demanding posterior segment cases referred from across China and internationally.
How CMCS Supported This Patient
China Medical Concierge – Shanghai (CMCS) coordinated the full care pathway: urgent case triage and specialist matching at Fudan University Eye Hospital, same-week MDT scheduling, pre-operative imaging logistics, on-site Mandarin-English interpretation for all consultations and surgical consent, accommodation near the hospital during the critical post-operative positioning period, and follow-up coordination for silicone oil removal and long-term visual rehabilitation.
For international patients facing time-sensitive retinal emergencies or complex vitreoretinal conditions in China, CMCS provides end-to-end support — from first contact to final visual outcome.
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