A 38-year-old healthy Indian woman presented with features consistent with unilateral left ARN. She gave history of chicken pox in childhood. A 1 week course of intravenous aciclovir followed by oral aciclovir and oral steroids resulted in improvement of clinical signs and maintenance of 6/9 vision with normal looking macula. Prophylactic barricade laser photocoagulation was applied surrounding the areas of retinal necrosis. Six weeks after presentation she complained of 2 days of blurred vision and metamorphopsia. Dense premacular fibrosis was noted with a macula hole confirmed on ocular coherence tomography (fig 1), Vision was 6/36. There was no peripheral detachment. She was listed for elective surgery. On review 6 days later, there was total retinal detachment (RD) with stiff looking folds (fig 2).

The posterior retina remained flat with a closed macular hole (fig 3). Eight months later, top-up laser, membrane peeling and combined lensectomy with oil removal were performed. There were severe anterior PVR changes flat on the buckle. She has been rendered aphakic and awaits a stable retina at 6 months postoperation for secondary intraocular lens implantation. Her vision at last review, 3 months after oil removal, was 6/18 (pinhole and +10D lens).

RD occurs in half of ARN eyes¹—35.3% of prophylactically lasered eyes still develop RD²; 96.3% of RDs occur 3 weeks after presentation.² Visual acuity after surgical repair only improves in a third of patients.²