Spontaneous Resolution of Tractional Retinal Detachment in a Type II Diabetic Patient

Abstract

A 43 years old male with diabetes type II was under treatment for diabetic retinopathy with extramacular tractional retinal detachment (TRD) in the left eye OS. During the follow-up visit, the patient had a drop in vision from 20/25 to 20/60. The TRD was found to have progressed to involve the macula and was threatening the fovea; therefore, vitrectomy was thought to be inevitable. Meanwhile, the patient adopted exercise and tight glycemic control, and during the preoperative evaluation of three months duration, we observed resolution of traction and return of visual acuity to baseline (20/20). In conclusion, spontaneous resolution of TRD is extremely rare. If it occurs, the patient may be spared from undergoing a vitrectomy.

Long-Standing Macula-Involving Diabetic Tractional Retinal Detachments with Good Visual Acuity: How Should We Manage These Patients?

“…If we consider ≥20/50 Snellen VA at the end of our study period as “stable or improved”, then the 55% and 41% of subjects in the Control and Study Groups, respectively, who maintained this level of VA are broadly on par with the study by Cohen et al 14 The study by Cohen et al 14 also noted that “spontaneous reattachment” occurred in 19.9% (27/136) of subjects managed by observation alone, and other authors have reported this as well when observation alone was the management strategy. 15 There were just three subjects in the Control Group of our study who were managed by observation alone, and none of these subjects experienced “spontaneous reattachment.” However, about 20% of the subjects in the Control Group experienced macular reattachment by the end of the study period following anti-VEGF treatment ± PRP but without undergoing PPV. Reattachment without PPV in macula-involving PDR-associated TRDs has been reported by other authors after anti-VEGF treatment and has been called the “favorable crunch”, although the incidence of this occurrence is unknown and has been sparsely reported-on.…”