SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY OF A MACULAR FOLD AFTER RETINAL DETACHMENT REPAIR Muge R. Kesen, MD,* Venkat M. Reddy, MD,† Adrienne W. Scott, MD*
Purpose: We report a case with a dry macular fold after retinal detachment repair using spectral-domain optical coherence tomography images (SD-OCT) to evaluate details of the retinal architecture before and after surgical management. Methods: A 62-year-old man diagnosed with macula-threatening rhegmatogenous retinal detachment underwent primary vitrectomy with an encircling sclera buckle. On post-operative day 5, he was noted to have developed a juxtafoveal retinal fold. SD-OCT was used to image the retinal fold and documented apposition of the retinal layers and discontinuity within the photoreceptor layer in the vicinity of the retinal fold. Results: The attempts to detach and unfold the retina appeared minimally successful intraoperatively. However, as the gas bubble decreased, the retinal fold was noted to have resolved. Repeat SD-OCT documented flattening of the retinal fold with a well-preserved photoreceptor layer. Conclusion: This outcome suggests the possibility of delayed postoperative success in flattening a retinal fold despite resistance to manipulation and failed attempts during the course of the surgery. To our knowledge, this is the first report that demonstrates this finding within the macular architecture after retinal detachment surgery in vivo using spectral-domain optical coherence tomography. These findings may have an important role in management of these cases and may become prognostic indicators based on the alterations in retinal anatomy demonstrated by high-resolution imaging. RETINAL CASES & BRIEF REPORTS 6:197–201, 2012
appears to play a role in clinical decision making. Macular involvement can result in poor visual acuity and symptomatic metamorphopsia. Conservative management may be appropriate for peripheral folds; however, symptomatic macular folds may warrant surgical management as there is evidence suggesting that retinal degeneration may occur as early as 1 week after retinal fold formation.1 We report a case of a dry macular fold after retinal detachment repair using spectral-domain optical coherence tomography (SD-OCT) images to illustrate details of the retinal architecture before and after surgical repair. To our knowledge, there are no published reports regarding use of SD-OCT in the imaging of retinal folds after retinal detachment repair. We report a case with dry macular fold after retinal detachment repair
From the *Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine, Baltimore, Maryland; and †Retina Group of Tidewater, Norfolk, Virginia.
R
etinal folds represent a relatively uncommon complication of retinal reattachment surgery. When associated with subretinal fluid, these folds may become less prominent, less elevated, or may even resolve spontaneously with total reabsorption of the fluid in the course of months without any surgical intervention. Although there is no consensus on as to how to manage this complication, the location of the fold The authors have no financial interest or conflicts of interest. Reprint requests: Adrienne W. Scott, MD, Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; e-mail: [email protected]
197
198
RETINAL CASES & BRIEF REPORTS´ 2012 VOLUME 6 NUMBER 2
using SD-OCT images illustrating the details of the retinal architecture before and after the surgical management. Case Report A 62-year-old man with an ocular history of remote LaserAssisted In Situ Keratomileusis (LASIK) surgery presented to an outside clinic for evaluation when he noticed an inferior visual field defect in his right eye. On examination, the visual acuity was 20/50 in the right eye and 20/25 in his left eye. Dilated ophthalmoscopy revealed macula-threatening rhegmatogenous retinal detachment resulting from a total of 7 tears located superiorly. The decision was made to repair the detachment with 20-gauge primary pars plana vitrectomy. Intraoperatively additional inferior retinal breaks were discovered, warranting a supplementary scleral buckle. After fluid-air exchange, subretinal fluid drainage was performed through one of the superior breaks. The retina flattened completely. Perfluorocarbon liquid was not used during this surgery. Endolaser was then applied to surround all retinal breaks and carried out to the ora serrata. A 240 encircling band was placed to surround the eye along with a 506G sponge. The retina remained attached during buckle adjustment, and all tears were supported by the scleral buckle and the sponge. The eye was again entered and any fluid that settled on the retinal surface was aspirated using a silicone-tipped needle. No additional gas exchange was performed. The eye was left filled with an air tamponade at physiologic intraocular pressure. On postoperative Day 5, despite a visual acuity of 20/300, the patient complained of metamorphopsia and difficulty focusing. He was noted to have developed a juxtafoveal fold through macula. After 4 weeks of postoperative observation, the patient was then referred to our practice for consultation. The visual acuity with spectacle correction measured 20/200 with pinhole improvement to 20/32 in his right eye and 20/16 in his left eye. Slit-lamp examination was unremarkable with early nuclear sclerotic changes bilaterally. Dilated extended ophthalmoscopy of the right eye showed a retinal fold extending from the superotemporal periphery into the macula, passing approximately 50 mm superior to the foveal center. The retina was attached in the periphery with an encircling band 360° and endolaser scars superiorly and inferiorly. Examination of the left eye showed a posterior vitreous detachment without any retinal abnormalities. Color fundus photographs and SD-OCT) images (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany) were obtained (Figure 1, A–C). The images demonstrated a juxtafoveal retinal fold without subretinal fluid just superior to the foveal center. Apposition of the retinal layers was noted, as was photoreceptor discontinuity in the region of the fold. The subfoveal photoreceptors were intact. Given the significant pinhole improvement to 20/32 in the right eye and the clinical appearance of the macular fold, a trial of glasses and observation with close monitorization was recommended. During his follow-up period at the outside office, he developed a recurrent superior retinal detachment resulting from a new retinal break located posterior to the buckle. The previous breaks were all supported by the buckle. He, therefore, underwent revision 20-gauge pars plana vitrectomy and gas tamponade. Intraoperatively, the subretinal fluid was noted to have approached the superotemporal arcade but did not extend into the macula. Attempts to detach the retina further posteriorly with subretinal infusion of balanced salt solution through the posterior break only resulted in a more bullous anterior detachment. A small slit retinotomy was then created temporal to the fovea. Attempts to unfold the retina
using injection of balanced salt solution into the subretinal space followed by massaging of the retina with the soft tip cannula and application of perfluorocarbon liquid failed to completely resolve the retinal fold. The retinal break and the retinotomy were then both completely surrounded by endolaser, and after fluid–air exchange, 10% perfluoropropane gas (C3F8) was used to fill the vitreous cavity for purposes of long-acting retinal tamponade. Although the attempts to flatten the retinal fold intraoperatively were not thought to be immediately successful during the surgery, as the gas dissipated over the course of 2 months, the retinal fold was observed to have completely flattened. The patient was instructed to maintain intermittent face-down positioning for 3 days immediately after the surgery. When the patient presented to our clinic for reevaluation 5 months after the second retinal reattachment surgery, the visual acuity with correction measured 20/63 with pinhole improvement to 20/50 in his right eye. The patient complained of resolved metamorphopsia, but decreased peripheral vision in his right eye with continued trouble with binocular focusing. Slit-lamp biomicroscopy revealed mild worsening of his nuclear sclerotic cataract, but a clear view to the fundus. On dilated ophthalmoscopy, the retina appeared flat and attached 360° with apparent resolution of the retinal fold. Color fundus photos and SD-OCT images were obtained that confirmed resolution of the juxtafoveal fold, and return of the native contour of the photoreceptor layer (Figure 2, A–C).
Discussion The formation of macular fold after use of intraocular air was first reported in 1984 by Pavan2 in a patient with a bullous superotemporal retinal detachment extending within the arcades. The air was thought to have moved over the detached retina from the anterior to posterior direction, causing a fixed retinal fold along the posterior edge of the detachment. Therefore, they suggested that patients be positioned in a way that would allow intraocular gas or air to initially move from an area of attached retina to detached retina to avoid accumulation of the subretinal fluid at the margin of the attached and detached retina because of gravitational forces. Positioning for residual subretinal fluid to gravitate away from the macula is also essential. Other risk factors for macular fold formation after vitrectomy for retinal detachment repair include multiple retinal tears, use of circumferential buckles, slippage of giant retinal tears, and incomplete drainage of subretinal fluid intraoperatively.3,4 Various techniques have been described to manage this rare but challenging complication. A localized macular detachment could be created by injection of subretinal balanced salt solution using 41-gauge cannula into the fold, followed by injection of gas and face-down positioning.5 Gentle prodding and massage using a soft tip cannula under heavy perfluorocarbon liquid (perfluoroperhydrophenanthrene; Vitreon) was also described as a management technique for long-standing dry retinal folds.6 The location of the retinal tear selected as a source for drainage of subretinal fluid
SD-OCT OF A MACULAR FOLD
199
Fig. 1. A. Fundus photograph of the right eye shows the symptomatic macular fold, located superior to the foveal center resulting in metamorphopsia. B. Spectral-domain optical coherence tomography illustrates the architectural details of the macular fold. C. Vertical cross section demonstrates apposition of the retinal layers within the fold involving the foveal center. No subretinal fluid is present. There is discontinuity within the photoreceptor layer.
during retinal reattachment has also been suggested as one of the possible risk factors for development of iatrogenic retinal folds. This is postulated to be a result of the difficulty in performing complete evacuation of the subretinal fluid through a peripheral retinal break as opposed to subretinal fluid drainage through an iatrogenic posterior retinotomy site, especially in large, bullous retinal detachments.7 In this case, attempts to detach, shift, and unfold the retina using infusion of fluid subretinally, manipulation with the soft tip cannula, or application of perfluorocarbon liquid appeared only minimally successful intraoperatively. However, the fold later resolved as the gas bubble gradually decreased in size with face-down positioning for 3 days. This outcome suggests the possibility of delayed postoperative success in flattening a retinal fold despite resistance to manipulation and
failed attempts during the course of the surgery. It is important, however, to perform these direct manipulations of the retina at a location outside of the macula when possible to minimize the risk of inadvertent foveal complications, such as foveal disruption, rupture, or alterations in the underlying retinal pigment epithelium. Animal models demonstrated the histologic appearance of the retinal folds as a linear elevation of the retina with the photoreceptors rotated into a base-to-base apposition on each internal surface.8 This finding is nicely confirmed in vivo in the human eye on the SD-OCT images in our patient (Figure 1). The vertical cross-section image demonstrates apposition of the retinal layers against each other within the fold. The photoreceptor layer appears intact in the subfoveal region. The hyperreflective line representing the inner and outer segment junction appears disrupted only
200
RETINAL CASES & BRIEF REPORTS´ 2012 VOLUME 6 NUMBER 2
Fig. 2. A. Fundus photograph of the right eye shows resolved macular fold and endolaser scars surrounding the retinotomy site located temporally in the macula. B. Spectral-domain optical coherence tomography shows flattening of the macular fold with residual surface irregularity. C. The vertical cross section demonstrates the complete resolution of the fold superior to the foveal center with trace amount of intraretinal fluid.
underneath the fold with a small hyperreflective area, which probably represents clustering of innermost retinal layers in that location. The photoreceptors appear to be properly appositioned against the retinal pigment epithelium except in a small, focal area corresponding to the retinal fold. The images also
demonstrate absence of intraretinal or subretinal fluid associated with the macular fold. The SD-OCT images obtained after the second surgery show complete flattening of the macular fold with residual surface irregularity located temporally corresponding to the area of retinal pigment
201
SD-OCT OF A MACULAR FOLD
epithelium alterations where endolaser was applied. The vertical cross section demonstrates the complete resolution of the fold superior to the foveal center. The retinal layers appear flat, aligned, and well preserved. The foveal contour and photoreceptor layer also appear well preserved, demonstrating anatomical success and theoretical potential for continued visual improvement. In selected cases, surgical repair may be appropriate to alleviate symptomatic metamorphopsia and possibly reduce the risk of progressive and irreversible retinal degeneration caused by the retinal fold. We found the SD-OCT images advantageous in evaluation of the anatomic details of the retina within the macular fold. These findings may have an important role in management of these cases and may become prognostic indicators based on the alterations in retinal anatomy demonstrated by high-resolution imaging. Key words: macular fold, perfluoropropane, retinal detachment surgery, retinal fold, spectral-domain OCT.
References 1. Hayashi A, Usui S, Kawaguchi K, et al. Retinal changes after retinal translocation surgery with scleral imbrication in dog eyes. Invest Ophthalmol Vis Sci 2000;41:4288–4292. 2. Pavan PR. Retinal fold in macula following intraocular gas. An avoidable complication of retinal detachment surgery. Arch Ophthalmol 1984;102:83–84. 3. Freeman HM, Schepens CL, Couvillion GC. Current management of giant retinal breaks. II. Trans Am Acad Ophthalmol Otolaryngol 1970;74:59–74. 4. van Meurs JC, Humalda D, Mertens DA, Peperkamp E. Retinal folds through the macula. Doc Ophthalmol 1991;78:335–340. 5. El-Amir AN, Every S, Patel CK. Repair of macular fold following retinal reattachment surgery. Clin Experiment Ophthalmol 2007;35:791–792. 6. Kertes PJ, Peyman GA. Management of dry retinal folds. Int Ophthalmol 1997;21:53–55. 7. Larrison WI, Frederick AR Jr, Peterson TJ, Topping TM. Posterior retinal folds following vitreoretinal surgery. Arch Ophthalmol 1993;111:621–625. 8. Machemer R, Aaberg TM, Norton EW. Giant retinal tears. II. Experimental production and management with intravitreal air. Am J Ophthalmol 1969;68:1022–1029.
Purpose: We report a case with a dry macular fold after retinal detachment repair using spectral-domain optical coherence tomography images (SD-OCT) to evaluate details of the retinal architecture before and after surgical management. Methods: A 62-year-old man diagnosed with macula-threatening rhegmatogenous retinal detachment underwent primary vitrectomy with an encircling sclera buckle. On post-operative day 5, he was noted to have developed a juxtafoveal retinal fold. SD-OCT was used to image the retinal fold and documented apposition of the retinal layers and discontinuity within the photoreceptor layer in the vicinity of the retinal fold. Results: The attempts to detach and unfold the retina appeared minimally successful intraoperatively. However, as the gas bubble decreased, the retinal fold was noted to have resolved. Repeat SD-OCT documented flattening of the retinal fold with a well-preserved photoreceptor layer. Conclusion: This outcome suggests the possibility of delayed postoperative success in flattening a retinal fold despite resistance to manipulation and failed attempts during the course of the surgery. To our knowledge, this is the first report that demonstrates this finding within the macular architecture after retinal detachment surgery in vivo using spectral-domain optical coherence tomography. These findings may have an important role in management of these cases and may become prognostic indicators based on the alterations in retinal anatomy demonstrated by high-resolution imaging. RETINAL CASES & BRIEF REPORTS 6:197–201, 2012
appears to play a role in clinical decision making. Macular involvement can result in poor visual acuity and symptomatic metamorphopsia. Conservative management may be appropriate for peripheral folds; however, symptomatic macular folds may warrant surgical management as there is evidence suggesting that retinal degeneration may occur as early as 1 week after retinal fold formation.1 We report a case of a dry macular fold after retinal detachment repair using spectral-domain optical coherence tomography (SD-OCT) images to illustrate details of the retinal architecture before and after surgical repair. To our knowledge, there are no published reports regarding use of SD-OCT in the imaging of retinal folds after retinal detachment repair. We report a case with dry macular fold after retinal detachment repair
From the *Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine, Baltimore, Maryland; and †Retina Group of Tidewater, Norfolk, Virginia.
R
etinal folds represent a relatively uncommon complication of retinal reattachment surgery. When associated with subretinal fluid, these folds may become less prominent, less elevated, or may even resolve spontaneously with total reabsorption of the fluid in the course of months without any surgical intervention. Although there is no consensus on as to how to manage this complication, the location of the fold The authors have no financial interest or conflicts of interest. Reprint requests: Adrienne W. Scott, MD, Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; e-mail: [email protected]
197
198
RETINAL CASES & BRIEF REPORTS´ 2012 VOLUME 6 NUMBER 2
using SD-OCT images illustrating the details of the retinal architecture before and after the surgical management. Case Report A 62-year-old man with an ocular history of remote LaserAssisted In Situ Keratomileusis (LASIK) surgery presented to an outside clinic for evaluation when he noticed an inferior visual field defect in his right eye. On examination, the visual acuity was 20/50 in the right eye and 20/25 in his left eye. Dilated ophthalmoscopy revealed macula-threatening rhegmatogenous retinal detachment resulting from a total of 7 tears located superiorly. The decision was made to repair the detachment with 20-gauge primary pars plana vitrectomy. Intraoperatively additional inferior retinal breaks were discovered, warranting a supplementary scleral buckle. After fluid-air exchange, subretinal fluid drainage was performed through one of the superior breaks. The retina flattened completely. Perfluorocarbon liquid was not used during this surgery. Endolaser was then applied to surround all retinal breaks and carried out to the ora serrata. A 240 encircling band was placed to surround the eye along with a 506G sponge. The retina remained attached during buckle adjustment, and all tears were supported by the scleral buckle and the sponge. The eye was again entered and any fluid that settled on the retinal surface was aspirated using a silicone-tipped needle. No additional gas exchange was performed. The eye was left filled with an air tamponade at physiologic intraocular pressure. On postoperative Day 5, despite a visual acuity of 20/300, the patient complained of metamorphopsia and difficulty focusing. He was noted to have developed a juxtafoveal fold through macula. After 4 weeks of postoperative observation, the patient was then referred to our practice for consultation. The visual acuity with spectacle correction measured 20/200 with pinhole improvement to 20/32 in his right eye and 20/16 in his left eye. Slit-lamp examination was unremarkable with early nuclear sclerotic changes bilaterally. Dilated extended ophthalmoscopy of the right eye showed a retinal fold extending from the superotemporal periphery into the macula, passing approximately 50 mm superior to the foveal center. The retina was attached in the periphery with an encircling band 360° and endolaser scars superiorly and inferiorly. Examination of the left eye showed a posterior vitreous detachment without any retinal abnormalities. Color fundus photographs and SD-OCT) images (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany) were obtained (Figure 1, A–C). The images demonstrated a juxtafoveal retinal fold without subretinal fluid just superior to the foveal center. Apposition of the retinal layers was noted, as was photoreceptor discontinuity in the region of the fold. The subfoveal photoreceptors were intact. Given the significant pinhole improvement to 20/32 in the right eye and the clinical appearance of the macular fold, a trial of glasses and observation with close monitorization was recommended. During his follow-up period at the outside office, he developed a recurrent superior retinal detachment resulting from a new retinal break located posterior to the buckle. The previous breaks were all supported by the buckle. He, therefore, underwent revision 20-gauge pars plana vitrectomy and gas tamponade. Intraoperatively, the subretinal fluid was noted to have approached the superotemporal arcade but did not extend into the macula. Attempts to detach the retina further posteriorly with subretinal infusion of balanced salt solution through the posterior break only resulted in a more bullous anterior detachment. A small slit retinotomy was then created temporal to the fovea. Attempts to unfold the retina
using injection of balanced salt solution into the subretinal space followed by massaging of the retina with the soft tip cannula and application of perfluorocarbon liquid failed to completely resolve the retinal fold. The retinal break and the retinotomy were then both completely surrounded by endolaser, and after fluid–air exchange, 10% perfluoropropane gas (C3F8) was used to fill the vitreous cavity for purposes of long-acting retinal tamponade. Although the attempts to flatten the retinal fold intraoperatively were not thought to be immediately successful during the surgery, as the gas dissipated over the course of 2 months, the retinal fold was observed to have completely flattened. The patient was instructed to maintain intermittent face-down positioning for 3 days immediately after the surgery. When the patient presented to our clinic for reevaluation 5 months after the second retinal reattachment surgery, the visual acuity with correction measured 20/63 with pinhole improvement to 20/50 in his right eye. The patient complained of resolved metamorphopsia, but decreased peripheral vision in his right eye with continued trouble with binocular focusing. Slit-lamp biomicroscopy revealed mild worsening of his nuclear sclerotic cataract, but a clear view to the fundus. On dilated ophthalmoscopy, the retina appeared flat and attached 360° with apparent resolution of the retinal fold. Color fundus photos and SD-OCT images were obtained that confirmed resolution of the juxtafoveal fold, and return of the native contour of the photoreceptor layer (Figure 2, A–C).
Discussion The formation of macular fold after use of intraocular air was first reported in 1984 by Pavan2 in a patient with a bullous superotemporal retinal detachment extending within the arcades. The air was thought to have moved over the detached retina from the anterior to posterior direction, causing a fixed retinal fold along the posterior edge of the detachment. Therefore, they suggested that patients be positioned in a way that would allow intraocular gas or air to initially move from an area of attached retina to detached retina to avoid accumulation of the subretinal fluid at the margin of the attached and detached retina because of gravitational forces. Positioning for residual subretinal fluid to gravitate away from the macula is also essential. Other risk factors for macular fold formation after vitrectomy for retinal detachment repair include multiple retinal tears, use of circumferential buckles, slippage of giant retinal tears, and incomplete drainage of subretinal fluid intraoperatively.3,4 Various techniques have been described to manage this rare but challenging complication. A localized macular detachment could be created by injection of subretinal balanced salt solution using 41-gauge cannula into the fold, followed by injection of gas and face-down positioning.5 Gentle prodding and massage using a soft tip cannula under heavy perfluorocarbon liquid (perfluoroperhydrophenanthrene; Vitreon) was also described as a management technique for long-standing dry retinal folds.6 The location of the retinal tear selected as a source for drainage of subretinal fluid
SD-OCT OF A MACULAR FOLD
199
Fig. 1. A. Fundus photograph of the right eye shows the symptomatic macular fold, located superior to the foveal center resulting in metamorphopsia. B. Spectral-domain optical coherence tomography illustrates the architectural details of the macular fold. C. Vertical cross section demonstrates apposition of the retinal layers within the fold involving the foveal center. No subretinal fluid is present. There is discontinuity within the photoreceptor layer.
during retinal reattachment has also been suggested as one of the possible risk factors for development of iatrogenic retinal folds. This is postulated to be a result of the difficulty in performing complete evacuation of the subretinal fluid through a peripheral retinal break as opposed to subretinal fluid drainage through an iatrogenic posterior retinotomy site, especially in large, bullous retinal detachments.7 In this case, attempts to detach, shift, and unfold the retina using infusion of fluid subretinally, manipulation with the soft tip cannula, or application of perfluorocarbon liquid appeared only minimally successful intraoperatively. However, the fold later resolved as the gas bubble gradually decreased in size with face-down positioning for 3 days. This outcome suggests the possibility of delayed postoperative success in flattening a retinal fold despite resistance to manipulation and
failed attempts during the course of the surgery. It is important, however, to perform these direct manipulations of the retina at a location outside of the macula when possible to minimize the risk of inadvertent foveal complications, such as foveal disruption, rupture, or alterations in the underlying retinal pigment epithelium. Animal models demonstrated the histologic appearance of the retinal folds as a linear elevation of the retina with the photoreceptors rotated into a base-to-base apposition on each internal surface.8 This finding is nicely confirmed in vivo in the human eye on the SD-OCT images in our patient (Figure 1). The vertical cross-section image demonstrates apposition of the retinal layers against each other within the fold. The photoreceptor layer appears intact in the subfoveal region. The hyperreflective line representing the inner and outer segment junction appears disrupted only
200
RETINAL CASES & BRIEF REPORTS´ 2012 VOLUME 6 NUMBER 2
Fig. 2. A. Fundus photograph of the right eye shows resolved macular fold and endolaser scars surrounding the retinotomy site located temporally in the macula. B. Spectral-domain optical coherence tomography shows flattening of the macular fold with residual surface irregularity. C. The vertical cross section demonstrates the complete resolution of the fold superior to the foveal center with trace amount of intraretinal fluid.
underneath the fold with a small hyperreflective area, which probably represents clustering of innermost retinal layers in that location. The photoreceptors appear to be properly appositioned against the retinal pigment epithelium except in a small, focal area corresponding to the retinal fold. The images also
demonstrate absence of intraretinal or subretinal fluid associated with the macular fold. The SD-OCT images obtained after the second surgery show complete flattening of the macular fold with residual surface irregularity located temporally corresponding to the area of retinal pigment
201
SD-OCT OF A MACULAR FOLD
epithelium alterations where endolaser was applied. The vertical cross section demonstrates the complete resolution of the fold superior to the foveal center. The retinal layers appear flat, aligned, and well preserved. The foveal contour and photoreceptor layer also appear well preserved, demonstrating anatomical success and theoretical potential for continued visual improvement. In selected cases, surgical repair may be appropriate to alleviate symptomatic metamorphopsia and possibly reduce the risk of progressive and irreversible retinal degeneration caused by the retinal fold. We found the SD-OCT images advantageous in evaluation of the anatomic details of the retina within the macular fold. These findings may have an important role in management of these cases and may become prognostic indicators based on the alterations in retinal anatomy demonstrated by high-resolution imaging. Key words: macular fold, perfluoropropane, retinal detachment surgery, retinal fold, spectral-domain OCT.
References 1. Hayashi A, Usui S, Kawaguchi K, et al. Retinal changes after retinal translocation surgery with scleral imbrication in dog eyes. Invest Ophthalmol Vis Sci 2000;41:4288–4292. 2. Pavan PR. Retinal fold in macula following intraocular gas. An avoidable complication of retinal detachment surgery. Arch Ophthalmol 1984;102:83–84. 3. Freeman HM, Schepens CL, Couvillion GC. Current management of giant retinal breaks. II. Trans Am Acad Ophthalmol Otolaryngol 1970;74:59–74. 4. van Meurs JC, Humalda D, Mertens DA, Peperkamp E. Retinal folds through the macula. Doc Ophthalmol 1991;78:335–340. 5. El-Amir AN, Every S, Patel CK. Repair of macular fold following retinal reattachment surgery. Clin Experiment Ophthalmol 2007;35:791–792. 6. Kertes PJ, Peyman GA. Management of dry retinal folds. Int Ophthalmol 1997;21:53–55. 7. Larrison WI, Frederick AR Jr, Peterson TJ, Topping TM. Posterior retinal folds following vitreoretinal surgery. Arch Ophthalmol 1993;111:621–625. 8. Machemer R, Aaberg TM, Norton EW. Giant retinal tears. II. Experimental production and management with intravitreal air. Am J Ophthalmol 1969;68:1022–1029.
