Pseudotumor cerebri induced by all-trans retinoic acid treatment of acute promyelocytic leukemia.

come clinically visible, resulting in the blue appearance of the sclera. We report the treatment of rhegmatogenous retinal detachment in 4 eyes of 3 patients with OI. Scleral buckling surgery, pneumatic retinopexy, and primary vitrectomy are the standards for repair of uncomplicated rhegmatogenous retinal detachments. In patients with OI, however, the thin sclera provides an increased risk of scleral perforation during the buckling procedure. In our first patient, demarcation laser photocoagulation was applied (5 years ago) and proved to be successful in preventing extension of the detachment. It has been reported that demarcation laser photocoagulation may be an effective method to manage acute or chronic macula-sparing shallow retinal detachments without proliferative vitreoretinopathy. Laser photocoagulation rapidly enhances retinal adhesion to 140% of normal in 24 hours and twice normal between 3 days and 4 weeks. For laser treatment to be effective, confluent laser photocoagulation burns should surround the entire detachment. In the left eye of our third patient, the presence of multiple inferior breaks and the extent of the detachment presented the options of scleral buckling or pars plana vitrectomy. Early in the procedure, it became evident that performing a scleral buckle was not possible. In our experience, the lack of blue discoloration of the sclera in the buckling area may be misleading when considering suture placement. In patients with OI, the sclera has an abnormal consistency, which may lead to inadvertent needle perforation, even with conservative suture depth. Pars plana vitrectomy in these patients may also be challenging. During vitrectomy, increased infusion pressure may be needed to prevent collapse of the globe during instrument exchange. This is secondary to the laxity of the sclera and its lack of rigidity. At the end of surgery, closure of the sclerotomy wounds with partial-thickness scleral sutures requires care to prevent perforation. Based on a MEDLINE search, this is the first report of treating retinal detachment in patients with OI with demarcation laser photocoagulation or pars plana vitrectomy. There are challenges facing the surgeon during vitrectomy surgery because of decreased scleral rigidity. The thin sclera in patients with OI makes the scleral buckling procedure a less desirable choice of treatment, even when the sclera appears white.