Sliding macular fold following retinal detachment surgery

[Macular folds after surgical repair of retinal detachment]

The incidence of retinal folds following surgical repair of retinal detachment is underestimated. The extent of retinal folds is variable and can include the complete retina with all layers and an apposition of the photoreceptor outer segments or only partially affect the outer or inner retinal layers. While complete folds can be relatively easily detected by clinical examination, discrete partial folds are sometimes difficult to assess biomicroscopically. In these cases, high-resolution optical coherence tomography (OCT) plays an important role as a tool for differential diagnosis. If macular translocation occurs during the formation of folds, mostly in associated with inferior retinal folds, patients often complain of binocular double vision. A significant reduction of visual acuity and metamorphopsia occur in cases where the folding involves the fovea. In general, retinal folds tend to resolve spontaneously over a prolonged period of follow-up of several months; however, in cases of foveal involvement and corresponding symptoms, a surgical revision can be indicated, although the surgical procedure is not standardized.

Laser treatment of macular retinal folds in late postoperative period after retinal detachment repair

Macular retinal folds are a rare yet grave complication of surgical rhegmatogenous retinal detachment repair. Clinical symptoms vary depending on the location and severity of folding. Fold located in the periphery of the ocular fundus can be asymptomatic, but macular retinal folds cause diminished visual acuity and metamorphopsia. Currently, the most effective treatment for retinal folds is repeat surgery. Its serious disadvantage is the risk of complications in the early postoperative period, including hemophthalmia, inflammation, secondary glaucoma, cataracts, RRD recurrence, macular tears, retinal vascular occlusion, etc. The clinical case described below demonstrates the potential of combination laser therapy for the treatment of macular retinal folds based on the use of modern diagnostic and therapeutic methods.

Inner, outer, and full-thickness retinal folds after rhegmatogenous retinal detachment repair: A review

Partial-thickness folds of the inner retina and outer retina, as well as full-thickness retinal folds, may occur after the repair of rhegmatogenous retinal detachment. Although these can look similar on clinical examination, imaging with optical coherence tomography facilitates differentiation. With optical coherence tomography analysis, inner retinal folds exhibit corrugations of the inner retina while outer retinal folds display hyperreflective lesions located just above the retinal pigment epithelium that may extend into the outer nuclear layer. In the case of a classic full-thickness retinal fold, all layers of the neurosensory retina may separate together from the retinal pigment epithelium with retinal reduplication and base-to-base photoreceptor orientation. We review the pathogenesis, risk factors, prevention, and management options of retinal folds. As the terminology for retinal folds is diverse, we highlight optical coherence tomography-based descriptions for retinal folds that have been used in the literature. Factors predicting visual recovery, mechanisms of spontaneous fold regression, and the effect of internal limiting membrane peeling on the incidence of folds are potential areas of future study.

OUTER RETINAL FOLDS FOLLOWING PARS PLANA VITRECTOMY WITH MEMBRANE PEEL

PURPOSE

To report a case of outer retinal folds following pars plana vitrectomy with epiretinal membrane peel.

METHODS

Retrospective case report. Spectral-domain and en face optical coherence tomography findings are described.

RESULTS

A 54-year-old man presented with distorted vision 1 month following pars plana vitrectomy with epiretinal membrane peel and subsequent cataract extraction. Optical coherence tomography of the affected eye revealed ripple-type and taco-type outer retinal folds. En face optical coherence tomography illustrated a curvilinear characteristic pattern of the folds that spontaneously resolved with follow-up.

CONCLUSION

The authors report a case of outer retinal folds developing in a patient following pars plana vitrectomy with membrane peel. En face optical coherence tomography findings of outer retinal folds may enhance diagnosis.

Long-Term Follow-Up of the Postoperative Macular Fold following the Vitreoretinal Surgery with Air Tamponade

A 64-year-old male who had a macula-on superior bullous retinal detachment in OD underwent scleral buckling, 20-gauge-pars plana vitrectomy, internal drainage of subretinal fluid with perfluorocarbon fluid, 360° endolaser and perflourocarbon-fluid-air exchange surgery. Patient sat upright immediately after the surgery for the night. At the first postoperative morning although the retina was attached, there was a macular fold extending toward the temporal retinal periphery. Patient denied further surgery. During the follow-up, retinal fold gradually became less visible and it could be noticeable only by fundus autoflorescence imaging at the sixth postoperative year with a subtle epiretinal membrane formation on the optical coherence tomographic section.

Longitudinal study of macular folds by spectral-domain optical coherence tomography

PURPOSE

To understand the natural history of macular folds using serial spectral-domain optical coherence tomography (SD-OCT).

DESIGN

Prospective case series.

METHOD

Serial OCTs were performed using Topcon 3D OCT. The main outcome measures were: patient demographics; preoperative, perioperative, and postoperative details; serial SD-OCTs; and length of follow-up.

RESULTS

Ten patients who underwent standard 3-port pars plana vitrectomy with gas tamponade to repair rhegmatogenous retinal detachment were included in this study. Mean follow-up was 9.9 months (range 5-17 months). Three types of retinal folds were identified: 1) ripple; 2) taco; 3) displacement. Ripple and taco folds were found to resolve spontaneously. Outer retinal hyperreflective lesions resolved first, followed by flattening of the inner retinal layers. Displacement folds also resolved, but left the macula translocated inferiorly, causing binocular diplopia.

CONCLUSION

Ripple and taco folds could be managed conservatively with good outcomes. However, the optimal treatment of displacement folds requires further research.

Spontaneous resolution of macular fold following retinal reattachment: morphologic features on SD-OCT

Macular fold is an infrequent complication after retinal detachment surgery. In this report, long-term changes of macular fold are demonstrated using spectral-domain optical coherence tomography. Although spontaneous resolution was noted in this study, spectral-domain optical coherence tomography revealed morphologic changes in the photoreceptor layer after resolution of macular fold, hyperreflective photoreceptor outer segment, and distorted Henle's fiber layer, which might be associated with poor visual outcome even after resolution of the fold.