The two extremes of retinal fold management

Abstract

Aims/Purpose: Retinal folds represent a debilitating complication following retinal detachment surgery. While some patients may experience partial retinal flattening with minimal or moderate improvement of visual function, many will go on to suffer severe permanent vision loss. The indication and timing of possible reintervention is still debated, particularly for how long after initial retinal fold formation there can still be a reasonable expectation of anatomical and functional improvement.Methods: We present the cases of two patients suffering debilitating postoperative macular folds at opposite ends of the intervention window, who were referred to the Jules Gonin Hospital at different postoperative timepoints following retinal detachment surgery. Patient Nr 1 was reoperated within 20 days of the initial surgery, patient Nr 2 10 months later. Retinal folds were confirmed by preoperative OCT and pre‐ and post‐op cyclotorsion was measured on fundus photography.Results: Patient Nr 1 recovered vision from CF to 0.2 logMar within 3 months, improving to 0.0 logMar after one year. Patient No 2 recovered from HM to 0.6 after 3 months and further to 0.5 logMar after one year. Most importantly, while patient Nr 1 had no more cyclotorsion, undisturbed binocular vision already on day one postoperatively, even to the absence of metamorphopsia during follow‐up, patient Nr 2 recovered slowly, also regaining binocularity without cyclotorsion, but with lasting metamorphopsia. During the video presentation, the different retinal elasticity at these differing timepoints can be demonstrated intraoperatively as well as different strategies to induce retinal separation so that the central retina can be reattached in a new, more physiological position.Conclusions: Our cases illustrate that early intervention can lead to a virtually symptom‐free result while even delayed intervention may still be able to achieve some improvement in visual function and the avoidance of monocularity.