Real-Time Resolution of Bacillary Layer Detachment in Rhegmatogenous Retinal Detachment Following Pneumatic Retinopexy

Purpose: To describe the in vivo hourly resolution of a bacillary layer detachment (BALAD) with an intact anterior wall in a patient with fovea-off rhegmatogenous retinal detachment (RRD). Methods: Case report. Results: A 58-year-old female patient presented with a fovea-off RRD and foveal BALAD with an intact anterior wall, with visual acuity of counting fingers at 3 feet. She underwent pneumatic retinopexy with an anterior chamber paracentesis and intravitreal injection of 0.6 cc of pure sulfur hexafluoride gas and was instructed to maintain face-down positioning for 6 hours. Hourly swept-source optical coherence tomography (SS-OCT) imaging with the PLEX Elite 9000 (Carl Zeiss, Dublin, California, USA) with high-definition horizontal spotlight scans and 12×12 mm raster scans demonstrated excellent structural recovery of the fovea. At the one-month follow-up, the retina remained attached with visual acuity improving to 20/100. Two months later, visual acuity improved to 20/30. The OCT showed significant recovery of the outer retinal bands, although a small sub foveal defect in the interdigitation zone (IZ) remained. Conclusion: This case highlights the importance of recognizing fovea-off RRD associated with BALAD, particularly when the anterior wall is intact. Urgent intervention can allow for foveal structural recovery potentially preventing the development of a BALAD-lamellar hole and full-thickness macular hole.