FOLLOW-UP OF A FULL-THICKNESS MACULAR FOLD FOLLOWING VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT

Abstract

Purpose: Retinal folds (RF) are an underestimated complication of rhegmatogenous retinal detachment (RRD) surgery. Our aim was to report a case of spontaneous resolution of a full-thickness RF with foveal involvement following an uncomplicated pars plana vitrectomy (PPV) with intraocular gas tamponade for a superior on-macula RRD.

Materials and Methods: Case report.

Results: A 61-year old male underwent PPV with fluid-air exchange and intraocular gas tamponade (SF6) in the left eye for a superior on-macula RRD with vitreous hemorrhage. At the end of surgery, the retina was attached with very marginal subretinal fluid. He assumed face down positioning immediately after surgery, followed by right cheek-to-pillow positioning a few hours later. One week later, the retina remained attached but the patient had developed a mildly symptomatic full-thickness RF with foveal involvement confirmed by optic coherence tomography (OCT). A conservative approach was carried out, with spontaneous progressive anatomical and functional improvement. Two months after surgery, there was only a residual RF on fundus examination and OCT and autofluorescence were unremarkable. The patient was asymptomatic and best corrected visual acuity was 20/25.

Conclusion: Full-thickness macular folds following RRD surgery may be present even after on macula RRD repair. Our case report illustrates that they may have a spontaneous regression with complete functional recovery, in accordance with a few other publications on this topic. As such, conservative management might be indicated even in full-thickness RF if the patient has few complaints and a reasonable visual function.

Keywords: retinal detachment surgery, residual subretinal fluid, intraocular gas tamponade, retinal fold, full-thickness macular fold