How to Prevent Retinal Shift after Rhegmatogenous Retinal Detachment Repair

Guber, Josef; Schawkat, Megir; Lang, Corina; Scholl, Hendrik P. N.; Valmaggia, Christophe

doi:10.1016/j.oret.2019.01.010

Cited by 32 publications

(30 citation statements)

References 18 publications

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“…This is likely due to the smaller amount of subretinal fluid left behind, which subsequently decreases the risk for macular slippage. On the other hand, younger patients were at greater risk of experiencing retinal shift [17]. This finding probably explains why younger patients complain more often about distorted vision postoperatively [8].…”

Section: Discussionmentioning

confidence: 99%

Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial

et al. 2019

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IntroductionTo evaluate the effect of postoperative posture on the retinal shift after retinal detachment repair.MethodsPatients who underwent pars plana vitrectomy (PPV) for macula-off rhegmatogenous retinal detachment (RRD) were included prospectively in the current study. Patients were randomized into two groups: group A included patients who did a log roll postoperatively, and group B included patients who had to lie flat on their backs for 6 h postoperatively before moving into the end position. Patients in group A and patients in group B were reviewed after 3 weeks and after 6 weeks, respectively, and fundus autofluorescence images (FAF) were obtained to visualize the retinal rotation.ResultsThe sample included 50 eyes from 49 patients. Retinal shift occurred after RRD repair in 17 patients (34%). There was no statistically significant difference between the two groups (p = 0.94). Postoperative macular shift occurred significantly less often (p = 0.049) in participants in whom heavy fluid was used in the procedure. Metamorphopsia was reported postoperatively by 10 of 17 patients with retinal shift (p < 0.001).ConclusionIn our study, postoperative posture did not significantly influence postoperative macular slippage after RRD repair. The use of intraoperative heavy liquid appears to be associated with a lower occurrence of retinal shift.

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Section: Discussionmentioning

confidence: 99%

Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial

et al. 2019

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“…Other studies showed that the use of intraoperative PFCL seems to be associated with lower occurrence of retinal shift after PPV for macula-off RRD [ 43 , 44 ]. Furthermore, even though previous studies suggested that the use of early face-down positioning in eyes with RRD treated with PPV and gas tamponade may prevent retinal displacement after surgery [ 45 ], it has recently been demonstrated that not only does postoperative posture seem to influence postoperative macular shift after surgery [ 43 , 44 , 46 ], but that this event seems to occur less than in other cases (range, 35%–72%) [ 42 , 45 , 47 – 49 ]. However, it is not clear whether the low reported rate of retinal shift is due to the no-prone posture or to the use of intraoperative PFCL in these cases.…”

Section: Discussionmentioning

confidence: 99%

“…Even though the number of anatomical surgical successes in retinal reattachment after PPV has increased in recent years, Dell'Omo et al reported unintentional displacement of the retina after the repair of primary and uncomplicated macula-off RRD with PPV in more than onethird of cases, despite postoperative prone posturing taken immediately after surgery and kept for 24 hours [42]. Other studies showed that the use of intraoperative PFCL seems to be associated with lower occurrence of retinal shift after PPV for macula-off RRD [43,44]. Furthermore, even though previous studies suggested that the use of early face-down positioning in eyes with RRD treated with PPV and gas tamponade may prevent retinal displacement after surgery [45], it has recently been demonstrated that not only does postoperative posture seem to influence postoperative macular shift after surgery [43,44,46], but that this event seems to occur less than in other cases (range, 35%-72%) [42,45,[47][48][49].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Vitrectomy without Using Perfluorocarbon Liquids and Drainage Retinotomy Associated with Postoperative Positioning Based on Residual Subretinal Fluid for Rhegmatogenous Retinal Detachment

Chelazzi

Azzolini

Bellina

et al. 2021

Journal of Ophthalmology

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Medical records of 75 eyes from 75 consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) were analyzed. Inclusion criteria were patients with RRD who underwent primary 23- or 25-gauge PPV with air, gas, or SiO tamponade and performed by a single surgeon, no use of perfluorocarbon liquids (PFCL) and drainage retinotomy, and follow-up ≥ six months. Exclusion criteria were patients who underwent previous vitreoretinal surgery, proliferative vitreoretinopathy (PVR) more than grade B, giant tears, and encircling band associated with PPV. The main endpoint was the anatomical retinal reattachment rate after a single surgical procedure. Secondary endpoints were best-corrected visual acuity (BCVA), postoperative retinal displacement, and intraoperative and/or postoperative complications. Primary anatomical success was achieved in 97.3% of cases using this modified surgical procedure. Retinal slippage occurred only in 28.2% of patients and it was not observed in all cases of macula-on RRD. The mean logMAR of the BCVA significantly improved in 92% of patients and no intraoperative complications were observed. The results suggest that complete subretinal liquid drainage is not mandatory for all RRD cases treated with PPV and that using PFCL and performing a drainage retinotomy are not essential in eyes with primary RRD and PVR less than grade B. Postoperative positioning after PPV for uncomplicated RRD based on the presence or absence of residual subretinal fluid at the end of surgery could limit the occurrence of postoperative retinal displacement, while promoting patient compliance.

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“…Two studies sought to further assess retinal displacement characteristics on imaging modality [ 5 , 14 ]. Of note, Schawkat et al 2019 and Guber et al 2019 use the same cohort to investigate the impact of PFCL and postoperative positioning, respectively, and therefore are referred to as Schawkat/Guber et al when the same information is presented in both articles [ 8 , 9 ].…”

Section: Resultsmentioning

confidence: 99%

“…A few studies have since suggested that retinal displacement could be responsible for symptoms such as vertical diplopia and distorted vision, which leave patients unsatisfied despite surgical success [ 4 – 9 ]. This study aims to review the literature on potential factors influencing retinal displacement as well as to provide a discussion on postoperative clinical outcomes and future research directions.…”

Section: Introductionmentioning

confidence: 99%

Retinal Displacement: Providing New Insights for Retinal Detachment Surgery

Houle

You

Hébert

et al. 2021

Journal of Ophthalmology

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Purpose. To review the current literature on retinal displacement and provide a discussion of potential risk factors, postoperative outcomes, and future directions. Methods. Two databases, MEDLINE and EMBASE, were mined using a directed search strategy to identify all articles on retinal displacement. Results. We identified 1522 articles. A total of n = 14 articles were retained. We provide an overview on the potential influence of surgical type (n = 4), tamponade agents (n = 5), postoperative posture (n = 6), and preoperative retinal status (n = 5) on incidence of retinal displacement and visual outcomes (n = 8). Discussion. Pars plana vitrectomy (PPV) with gas tamponade is associated with displacement rates of up to 72%, typically in a downward direction. Meanwhile, pneumatic retinopexy and PPV with silicone oil may offer similar surgical success with a significantly lower risk of displacement. The impact of heavy liquids such as perfluorocarbon liquid, postoperative positioning and preoperative extent of detachment on displacement remains inconclusive. Patients with displacement had a significantly lower visual acuity and higher rates of distortion than those without displacement. However, not all patients with displacement experienced visual symptoms. Conclusion. Retinal displacement is a new concept in our understanding of retinal detachment. Additional studies are needed to better define its impact on postsurgical outcomes.

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How to Prevent Retinal Shift after Rhegmatogenous Retinal Detachment Repair

Cited by 32 publications

References 18 publications

Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial

Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial

Efficacy and Safety of Vitrectomy without Using Perfluorocarbon Liquids and Drainage Retinotomy Associated with Postoperative Positioning Based on Residual Subretinal Fluid for Rhegmatogenous Retinal Detachment

Retinal Displacement: Providing New Insights for Retinal Detachment Surgery

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