Macular translocation a risk after retinal detachment surgery
MedWire News: Study findings suggest that inadvertent macular translocation can occur following repair of macula-off retinal detachment, and may be a significant contributor to poorer visual outcome after retinal detachment despite surgical success.
"While the anatomical success rate of single surgery may be as high as 94%, the recovery of vision is often delayed and variable," say Alex Hunyor (Macquarie University, Sydney, Australia) and colleagues.
Hunyor and team performed surgical repair of five eyes from five patients with postoperative macula-off rhegmatogenous retinal detachment detected by fundus autofluoresence imaging. Regular postoperative follow-up was performed, including macular optical coherence tomography (OCT) and fundus autofluorescence.
Main outcome measures included visual acuity and subjective visual symptoms in patients with anatomically successful retinal detachment repair, in whom inadvertent macular translocation was noted. The phenomenon occurred in one patient after sclera buckling surgery, in contrast to previous reports.
Four of the five patients underwent vitrectomy for repair of retinal detachment using 23-gauge pars plana vitrectomy (PPV). After PPV was completed, all patients had internal drainage of subretinal fluid via a posterior drainage retinotomy.
Retinal attachment surgery was successful in all five patients, with persistent diplopia occurring in two patients. One patient complained of metamorphopsia at 3 months postoperatively, in the absence of clinical or high-resolution OCT evidence of macular abnormality. No other persistent complications were identified.
Discussing the possible reasons for retinal displacement after surgery, the researchers say: "It is presumed that in the immediate period after surgery, a small amount of subretinal fluid persists, which allows the retina to displace inferiorly under the influence of gravity, if the patient assumes an upright position."
"Therefore, we would emphasize the importance of promptly assuming and maintaining the appropriate face-down position following repair of macula-off retinal detachment."
The authors also note that they performed internal drainage of subretinal fluid via the retinal break and a posterior drainage retinotomy in all four patients who underwent PPV. In contrast, internal drainage via the peripheral break alone could result in a greater amount of residual fluid and increased risk for translocation. They add that use of perfluorocarbons for retinal flattening is a useful adjunct to this procedure that can obviate the need for posterior drainage retinotomy.
"Our limited case series demonstrates the phenomenon of macular translocation after successful retinal detachment repair, detected by fundus autofluorescence imaging," say the authors in the journal Clinical and Experimental Ophthalmology.
"Fundus autofluorescence represents a useful tool in the postoperative assessment of patients after retinal detachment repair, particularly when the visual outcome is suboptimal and no abnormality is evident on clinical examination or other investigation such as OCT."
By Ingrid Grasmo