Retinal folds through the macula

Abstract

In a series of 137 consecutive conventional primary retinal detachment repairs we postoperatively found retinal folds through the macula in four cases (2.8%). All four patients had presented with an acute, bullous, superior detachment, and had been treated with an encircling band, drainage of subretinal fluid, injection of an air/gas mixture, cryocoagulation, and a radial buckle to close the largest retinal tear. Redundant retina (created by the encircling band and possibly by stretching in the bullous detachment) became folded either by compression by the gas-bubble in the recumbent patient, or by a steam roller action of the bubble when the patient sat up. In acute bullous detachments, we try to avoid this complication by using an air/gas bubble which is not greater than necessary to tampon the retinal break, and by positioning the patient in such a way that residual subretinal fluid is pressed away from the posterior pole.

Spontaneous regression of a retinal fold a year after scleral buckling and intravitreal injection of gas

“…3,4 We show that HD-OCT can potentially visualize the nematode even through hazy vitreoretinal inflammation. This report shows that HD-OCT offers a valuable noninvasive technique to image eyes with DUSN.…”

“…3 If the SRF is then absorbed, an arcuate retinal fold could remain, and if the macula is involved, vision could be impaired. [1][2][3][4] Surgical treatment of symptomatic retinal folds with vitrectomy, induction of an RD with injection of saline subretinally, and relocation of the retina with gas 5 or with perfluorohexy-loctane(F 6 H 8 ) 6 have been reported in the literature. In our patient, the retinal fold did not involve the fovea; however, it distorted the macular (Figure 1) area causing metamorphopsia and decreased VA. As the indentation of the buckle diminished in height within the next months, the retina gradually unfolded and VA was completely restored.…”

Retinal Folds following Retinal Detachment Surgery

“…Only a small number of case series have been published [7,8,9]. One publication commented on the incidence in a consecutive series of 137 patients treated with scleral buckling surgery [10]. The authors found a relatively high number of macular folds in 4 of 136 cases (2.8%).…”

“…• Large and circumferential buckles [5,9,10] – the larger the buckle, the smaller the intraocular volume and the more redundant retina is there to form a fold. In most cases described after scleral buckling surgery, a circumferential exoplant either alone or in combination with a radial exoplant was used, whereas macular folds following a single small radial implant seem to be a rarity [9].…”

“…• Recent onset of retinal detachment [10] – subretinal fluid has a relatively low viscosity and cellularity, resulting in a quicker reabsorption of subretinal fluid. In addition, the retina is more elastic compared with a relatively stiffer retina in long-standing cases.…”