Supplementary Material for: Ultra-wide field optical coherence tomography in transvitreal and subretinal fibrinoid syndrome: a case report

Introduction We report a case of fibrinoid reaction after diabetic vitrectomy surgery. Clinical course, management and multimodal imaging including evaluation with ultra-wide field optical coherence tomography (OCT) will be reported. Methods A case report of a male patient with severe fibrinoid reaction with both intravitreal fibrin bands and subretinal fibrin and fluid following vitrectomy for diabetic retinopathy. He was managed with intravitreal injection (IVI) of tissue plasminogen activator (TPA), followed by fluid-air exchange and air-fluid exchange to remove the fibrin degradation product 2 days later. About 1 millimeter air was left inside the vitreous cavity for air tamponade to displace the remains of subretinal fibrin with another IVI of 25 µg TPA at the mean time. Posterior subtenon and suprachoroidal injection of triamcinolone was performed during the course. Results OCT including ultrawide field OCT showed transvitreal fibrin bands, subretinal fibrin, as well as subretinal fluid in the right eye. The degradation of intravitreal fibrin bands, as well as decrease of subretinal fluid were noted 2 days after intravitreal TPA and suprachoroidal injection of triamcinolone acetonide. The subretinal fibrin was subtotally reabsorbed and displaced after repeated injection of TPA and air tamponade another 1 week later. Subsequent follow up showed complete resolution of subretinal fibrin and subretinal fluid as well as improved visual acuity. Conclusion We describe a case of fibrinoid reaction after vitrectomy for diabetic retinopathy which was successfully treated. Wide-field OCT may also be used to assist in the recognition of this complication.