On the basis of the echographic findings, the patient was taken to the operating room to repair the retinal detachment. During anterior chamber washout, the crystalline lens prolapsed partly into the anterior chamber due to a zonular dehiscence extending clockwise from the 6-o’clock to the 12-o’clock position, indicating traumatic subluxation of the lens. Therefore, the lens was removed via a pars plana approach.

After the vitreous hemorrhage was removed via vitrectomy, a rhegmatogenous retinal detachment was evident. The detachment involved the macula and extended clockwise from the 5-o’clock to the 8-o’clock position out to the periphery, but did not extend superiorly to the superotemporal arcade. The detachment arose from a traumatic macular hole. Commotio retinae surrounded the macular hole and involved much of the area centralis. Extensive intraretinal hemorrhage was evident, inferior to the area of commotio retinae. Some areas of subretinal hemorrhage were also present, that were drained through the macular hole. An inferotemporal peripheral choroidal hemorrhage was present between the 7-o’clock andthe 8:30-o’clock position. Advanced glaucomatous cupping of the optic nerve was observed.

Peripheral fundus examination disclosed no retinal breaks, but numerous areas of lattice degeneration were present. To avoid laser application to the macular hole and to provide rapid visual rehabilitation to this monocular patient, silicone oil was used for retinal tamponade, and an inferior iridectomy was created at the 6-o’clock position.