Rhegmatogenous retinal detachment and full-thickness macular hole induced by lightning

A 31-year-old gentleman was remotely struck by lightning and complained of blurred vision in his left eye. He was diagnosed with left eye anterior uveitis and full-thickness macular hole (FTMH), and subsequently referred for vitreoretinal intervention. On examination, his left-eye vision was hand movement. Anterior uveitis had resolved with no cells in the anterior chamber. Posterior subcapsular cataract 2+ was noted. There was a FTMH and partial posterior vitreous detachment (PVD) confirmed by optical coherence tomography (OCT). Right eye was normal with 6/6 vision. At one- month follow-up, the macular hole was closed spontaneously but localised rhegmatogenous retinal detachment (RRD) was noted in the inferior retina with macula-on. There were multiple holes in the inferior equatorial region surrounded by hyper- and hypopigmented retinal atrophy. The patient underwent phacoemulsification, intraocular lens implantation, vitrectomy, and gas tamponade (C3F8 14%). At one week postoperative, he had recurrent retinal detachment with multiple new atrophic holes noted. He underwent a second vitrectomy with silicone oil tamponade. Best-corrected visual acuity (BCVA) in his left eye two months after surgery was 6/45 and the retina had reattached.