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This 82YO male was referred for asymptomatic blood in his right eye. Vision was 20/40 OD.
Optos color RGB imaging shows yellow and red subretinal blood in the inferonasal midperiphery. Triton swept-source OCT shows a relatively thickened choroid for an 82YO, and choroidal en face shows an abnormal inferior dilated choroidal vortex system which extends across the horizontal meridian and drains the entire macula.
Learning Points:
Ectopic choroidal neovascularization (CNV) can often masquerade as a choroidal mass or uveal melanoma. It can also cause extensive choroidal/suprachoroidal, subretinal, and vitreous hemorrhage, more commonly in patients who are on blood thinners. The subretinal blood often spontaneously regresses without treatment, although anti-VEGF injections can be used for symptomatic or increasing exudation. We recommended observation for our patient.
Pachychoroid, meaning “thick” choroid, is secondary to large, dilated Haller vessels. Increased oncotic/mechanical pressure from these dilated vessels can cause RPE dysfunction, serous detachments, and macular neovascularization. What defines a ‘pachy’ choroid remains quite unclear (Spaide, Retina 2021;41:231-237), since pachychoroid-related findings can be present despite a ‘normal’ macular choroidal thickness as in our patient. Spaide recently described venous overload choroidopathy, a unifying concept that better explains the underlying pathogenesis (Progress Retinal Eye Research 2022;86:100973).
The pachychoroid spectrum also includes ectopic neovascularization (aka peripheral exudative hemorrhagic chorioretinopathy), with the choroid showing progressive thickening towards the temporal periphery (Shroff et al, Retina 2021;41:1518-1525).
Int J Retina Vitreous. 2026 Jun 25;12(1):122. doi: 10.1186/s40942-026-00890-7.
PPV RRD Evidence doesn’t support superiority of prone positioning, which should be determined by break location and other patient-specific factors — Systematic review and Meta-analysis
Introduction: Rhegmatogenous retinal detachment (RRD) is a serious ophthalmic pathology managed with pars plana vitrectomy (PPV) with gas tamponade. Even though prone position after surgery is widely used, it has been questioned because of high patient discomfort and contradictory evidence concerning its effects on functional outcomes.
Objective: To assess the effect of various positioning options post-surgery on the rate of retinal reattachment and visual outcome after PPV for RRD.
Methods: A systematic review and meta-analysis were carried out in accordance with the PRISMA statement. Searches for related papers in PubMed, Scopus, and Web of Science databases were made up to April 2026. Articles describing postoperative positioning after PPV for RRD were considered for inclusion. Primary outcomes were retinal reattachment rate and changes in best corrected visual acuity (BCVA).
Results: Ten studies with 1262 eyes were included. Pooled analysis showed no statistically significant difference in retinal reattachment rate between prone/face-down positioning and support-the-break/adjustable positioning (RR = 0.96, 95% CI 0.84 to 1.11, p = 0.231), with moderate heterogeneity. The evidence for reattachment rate outcome was of low certainty. Two studies with 90 eyes showed a very small borderline difference in logMAR BCVA change in favour of prone positioning versus supine positioning (MD = -0.07, 95% CI -0.14 to 0.00, p = 0.049). However, the certainty of evidence for this comparison was very low. The clinical relevance of this small difference is uncertain. Descriptive single-arm analyses demonstrated postoperative improvement in BCVA for both the prone and supine positioning arms, nonetheless, there was significant heterogeneity in these analyses.
Conclusion: In the pooled analysis, there was no statistically significant difference in the rate of retinal reattachment between prone positioning and support-the-break positioning after PPV for RRD, and the certainty of evidence for this outcome was low. For BCVA, the pooled analysis showed a small borderline difference in logMAR BCVA in favour of prone positioning versus supine positioning. However, the certainty of evidence for this comparison was very low and the clinical importance of this finding is unclear. Thus, the current evidence does not allow a strong conclusion of clinically meaningful functional superiority of prone positioning. Postoperative positioning should be determined by the location of the retinal break, the tamponade agent, surgical factors, patient tolerance, and the judgment of the clinician.
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