Elsevier

Ophthalmology

Volume 117, Issue 1, January 2010, Pages 86-92.e1
Ophthalmology

Original article
Unintentional Displacement of the Retina after Standard Vitrectomy for Rhegmatogenous Retinal Detachment

https://doi.org/10.1016/j.ophtha.2009.06.025Get rights and content

Objective

To study unintentional displacement of the retina after standard vitrectomy for rhegmatogenous retinal detachment (RRD).

Design

Prospective interventional case series.

Participants

Forty-three eyes of 43 consecutive patients with cystic RRD involving 1 or more quadrants underwent successful standard vitrectomy with 20% sulfur hexafluoride gas injection. Neither scleral buckling nor retinotomy was performed.

Methods

Fundus autofluorescence (FAF) imaging was subsequently recorded to detect displacement of the retina using the Topcon TRC-50DX (Topcon, Tokyo, Japan) at 10 days and 1, 3, and 6 months postoperatively. Fluorescein angiography was also recorded using standard techniques for patients with abnormal FAF findings. Cyclotorsion and vertical deviation were measured postoperatively.

Main Outcome Measures

The proportion of eyes with postoperative retinal displacement detected by FAF imaging.

Results

The mean age of these 43 patients was 60 years with a range of 39 to 77 years. Of the 43 eyes, retinal detachment involved 1 quadrant in 2 eyes, 2 quadrants in 31 eyes, 3 quadrants in 8 eyes, and 4 quadrants in 2 eyes. After complete reattachment of the retina, FAF photography demonstrated hyperfluorescent lines superiorly parallel to retinal vessels within the vascular arcade in 27 of the 43 eyes (62.8%). Fluorescein angiography did not demonstrate any abnormalities corresponding to the linear autofluorescence. This autofluorescence was hypothesized to originate from increased metabolic activity of the retinal pigment epithelium that had been preoperatively located under the major retinal vessels and was postoperatively exposed to light because of downward displacement of the retina. Of the 27 eyes with retinal displacement, 1 to 5 degrees of extorsion were seen in 16 eyes (59.3%), and 1 to 4 degrees of vertical deviation were seen in 13 eyes (48.1%). None of the 27 patients had diplopia or slant. The extent of retinal detachment (P = 0.019) and the macular status (on or off) (P = 0.016) were significantly associated with postoperative displacement of the retina.

Conclusions

In eyes with RRD treated with standard vitrectomy and gas injection, the retina may move downward after the surgery. If the extent of retinal detachment is large, or macular detachment is present, unintentional postoperative retinal translocation may easily occur.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients

Forty-three eyes of 43 consecutive patients with RRD involving 1 or more quadrants underwent successful standard PPV with 20% sulfur hexafluoride gas injection at the Kagawa University Hospital between November 2006 and June 2008. The mean age of all patients (26 male, 17 female) was 60.0 years with a range of 39 to 77 years. No patients had binocular diplopia in their preoperative history. The eyes with reoperations, silicon oil tamponade, or proliferative vitreoretinopathy were excluded from

Results

On preoperative fundus examinations, 43 eyes had bullous RRD involving 1 or more quadrants. Of the 43 eyes, RRD involved 1 quadrant in 2 eyes, 2 quadrants in 31 eyes, 3 quadrants in 8 eyes, and 4 quadrants in 2 eyes on fundus examination. Retinal breaks were located in the superior region (19 eyes), the temporal region (13 eyes), the nasal region (5 eyes), the inferior region (1 eye), and multiple regions (5 eyes).

After complete reattachment of the retina, autofluorescence photography

Discussion

Fundus autofluorescence is a noninvasive test that provides discrete funduscopic images based on stimulated emission of light from lipofuscin. Lipofuscin is a cellular waste product containing lipid, protein, and fluorophores such as A2E. Visualization of the signal depends on the distribution pattern of the fluorophore-containing lipofuscin.10, 11, 12 FAF imaging allows topographic mapping of lipofuscin distribution in the RPE cell monolayer, as well as of other fluorophores that may occur

References (22)

  • M.R. Comaratta et al.

    Perfluorocarbon liquids in the management of complicated retinal detachments

    Curr Opin Ophthalmol

    (1991)
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      Several other anatomic abnormalities following RRD repair can be seen with multimodal imaging. Retinal displacement is detected with FAF (Shiragami et al., 2010) and outer retinal folds are detected with FAF and both cross-sectional and enface OCT (dell’Omo et al., 2012; Fukuyama et al., 2019; Lee et al., 2021a). Adaptive optics-assisted retinal imaging (AO) provides another imaging modality that can be used to assess photoreceptor density, spacing and regularity following RRD repair, and may provide other imaging biomarkers that can be assessed post-operatively (Saleh et al., 2014; Potic et al., 2020; Reumueller et al., 2020).

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    Manuscript no. 2009-186.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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