Spontaneous Retinal Reattachment following Multiple Vitreoretinal Interventions: Case Report

In the realm of retinal disorders, spontaneous retinal reattachment is a rare yet compelling phenomenon, offering unique insights into the natural reparative capabilities of ocular tissues. Although not unprecedented, these instances remain scarce and are typically reported under exceptional circumstances, such as following partial surgical interventions or in patients with atypical clinical histories. The underlying mechanisms, ranging from vitreous syneresis and chorioretinal adhesion formation to the enigmatic resolution of subretinal fluid, continue to pique clinical curiosity.

For the retina specialist, each case of spontaneous retinal reattachment is a potential window into the intricate processes governing retinal pathology and repair. A deeper understanding of these spontaneous occurrences is invaluable as it could unveil new aspects of retinal healing. Here, we present a case that challenges conventional wisdom and enriches our knowledge of retinal detachment and reattachment dynamics.

This case report follows a retrospective review of the clinical course of a patient who experienced spontaneous retinal reattachment after multiple unsuccessful vitreoretinal surgeries. The patient’s medical records were meticulously examined, including preoperative and postoperative imaging, surgical notes, and follow-up examination findings.

The patient initially presented with a macula-on rhegmatogenous retinal detachment OD. Initial examination revealed a visual acuity of 20/100 (Snellen) in the right eye, with an intraocular pressure (IOP) of 11 mm Hg. Fundus examination indicated a superior bullous RD. The patient did well but developed a complex RD with proliferative vitreoretinopathy and a full-thickness macular hole (shown in Fig. 1).

The RD was addressed via pars plana vitrectomy with internal limiting membrane peeling, endolaser, silicone oil (SO) 1,000 injection, and methotrexate 400 μg administration. Postoperatively, the patient was closely monitored for 4 months, during which the retina remained attached, IOP stable, and visual acuity improved to 20/100. After 7 months, vitrectomy with SO removal was performed (shown in Fig. 2); however, 6 weeks after SO removal, the patient developed a tractional retinal detachment with associated myopic foveoschisis in the posterior pole and a drop in vision to HM OD (shown in Fig. 3). At this time, despite additional surgical efforts, the patient declined further interventions. After 18 weeks, a surprising, spontaneous resolution of the tractional RD, retinal schisis, and improvement in choroidal folds were revealed. The patient’s visual acuity stabilized at Dcc20/125, and IOP was reduced to 15 mm Hg; follow-up at 1 year revealed a stable retina (shown in Fig. 4). The patient was followed for 10 weeks, and her retina remained attached. At her last follow-up, the retina remained attached, visual acuity remained Dcc20/125, and IOP was 15 mm Hg.

The significance of this case report lies in its rarity and the potential insights it offers into the eye’s self-healing properties. The spontaneous resolution of a complex retinal detachment with associated myopic foveoschisis following multiple vitreoretinal surgeries challenges current understanding. It prompts a re-evaluation of the factors contributing to ocular tissue repair and regeneration.

The recent literature supports the investigation into spontaneous retinal reattachment. Ono et al. [1] previously described a case of development and spontaneous resolution of a foveoschisis with retinal detachment years following cataract surgery. A similar case reported in PubMed discussed the spontaneous resolution of tractional retinal detachment in a type II diabetic patient, where improved glycemic control and exercise seemed to contribute to the resolution of the detachment without the need for vitrectomy [2]. Another study investigated the characteristics of spontaneous reattachment of rhegmatogenous retinal detachment, highlighting that spontaneous reattachment of rhegmatogenous retinal detachment usually involves the inferior or temporal retina and is associated with severe disruption of the retinal microstructure. This condition was stable, but long-term follow-up was recommended to monitor the progression of the epiretinal membrane [3].

Theories on mechanisms for spontaneous reattachment and foveoschisis resolution often focus on factors that reduce vitreous traction. For example, immobilization of the affected eye, reducing dynamic fluid forces on the retina, has been suggested as a potential factor. However, our patient did not undergo any such movement restrictions. Another plausible theory involves the closure of retinal tears with glial scars, which reduces vitreous traction, as highlighted by Orazbekov et al [4]. This mechanism aligns more closely with our case, where the trampoline retinal detachment was attached at the periphery before spontaneously reattaching.

This case enriches the knowledge of rare ocular phenomena, stimulating further research into potential mechanisms driving such processes. There is a possibility of an unidentified physiological trigger or a healing threshold that enables the retina to reattach spontaneously. Understanding these mechanisms could open new avenues for therapeutic strategies, especially in retinal detachment cases refractory to conventional surgical treatments. Such insights could be vital in enhancing patient outcomes and developing novel, less-invasive treatment options.

In conclusion, while the spontaneous resolution of a foveoschisis and reattachment of the retina is rare, each documented case offers valuable insights into the natural reparative mechanisms of the eye. The understanding gained from these cases could significantly impact the development of future therapeutic approaches in ophthalmology. The CARE Checklist has been completed by the author for this case report and is attached as online supplementary materials (for all online suppl. material, see https://doi.org/10.1159/000540346).

Written informed consent was obtained from the patient for publication of the details of their medical case and any accompanying images. Patients provided informed consent for diagnosis, treatment, and follow-up, as per the standard of care in the USA. Ethical approval is not required for this study in accordance with local or national guidelines.

D.R.P.A. received support from Acylerin, Alcon, Alimera Sciences, Allergan/AbbVie, Bausch + Lomb, Bayer, Boehringer Ingelheim, Citrus Therapeutics, Clinical Trials Network, Eyepoint Pharmaceuticals, Genentech, Gyroscope Therapeutics, Novartis, Ocugen, Opthea, Regeneron, Regenxbio, Roche, Samsara Vision, and the Spherix Consulting Group. E.K.C. received support from Alimera Sciences, Allergan, Bayer, Citrus Therapeutics, Clearside Biomedical, Genentech, Hexal AG/Sandoz Inc., IVERIC Bio, Kodiak Sciences, Novartis, Opthea, Regeneron, and Valo Health Inc. N.N.W. has no conflicts of interest to declare.

No funding was received for the completion of this manuscript.

N.N.W. wrote the manuscript and performed a literature review of the case reports. E.K.C. and D.R.P.A. supervised the writing and submission of this case report. The patient received direct clinical care from D.R.P.A., N.N.W., E.K.C., and D.R.P.A. reviewed the manuscript before submission.

All data generated or analyzed during this study are included in this article and its supplementary material files. Further inquiries can be directed to the corresponding author.