First Author: X.Valldeperas SPAIN
Co Author(s): E. Pedemonte
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To discuss a surgical procedure for the management of a retinal fold affecting the macular area after an encirclement, pars plana vitrectomy (PPV) and gas tamponade for the treatment of a macula-off retinal detachment (RD).
Ophthalmology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Spain). Universitat Autònoma de Barcelona
A 43 year-old woman with a macula-off RD complaint of decreased vision for 2 weeks. Best-corrected visual acuity (BVCA) was 20/400 with -5.00D. Retinal tears were detected at 7 and 9 clock hours. The patient underwent encirclement and 23G PPV with endolaser around the breaks and perfluorpropane (C3F8) tamponade. She was asked to maintain a facedown position 24 hours after the surgery, followed by lateral positioning on the opposite side of the breaks. One month after the surgery, BCVA improved to 20/200 but the patient complaint of visual distortion. Fundoscopy showed a radial full-thickness retinal fold affecting the macula.
The patient was proposed for combined phacoemulsification, intraocular lens implantation and PPV with subretinal balanced-salt solution injection directly under the macular fold. A partial RD was then induced in the fold area to unfold it. Perfluorocarbon liquid was then injected on the macula and subretinal fluid was displaced away from the macular fold. Fluid-air exchange was done and C3F8 endotamponade was left in the eye. The patient was instructed to strictly keep a facedown position for one week. One month later, retina was attached and BCVA improved to 20/100. Macular fold was significantly displaced and subjective visual distortion improved.
Retinal fold is a rare but severe complication after PPV and gas endotamponade for macula-off RD, especially when it affects the macula and generates metamorphopsia. It is more frequent when encirclement is associated with the PPV and if the patient does not adopt a facedown position when significant subretinal fluid is left at the end of the vitreoretinal surgery. We present a simple surgical technique to move the fold away from the fovea and ameliorate visual prognosis. But we still advocate for the prevention as the best treatment of macular folds after PPV for the management of a macula-off RD.