OBJECTIVE: Retinal displacement following rhegmatogenous retinal detachment (RRD) has been associated with inferior functional outcomes. Recent evidence using an overlay technique suggests that fundus-autofluorescence underestimates post-RRD repair retinal displacement. This study aims to validate the overlay technique in normal eyes and to determine its sensitivity and specificity at detecting retinal displacement.
METHODS: We conducted a retrospective case series involving 66 normal eyes, each with at least two separate infrared (IR) images at different time points. Overlay of the two images was based on manual marking of choroidal and optic nerve head (ONH) landmarks. For each set of two IR images, computer code for homography generated two outputs, flipping view video and an overlay picture. First, validation of choroidal/ONH alignment was performed using the flipping view video to ensure accurate manual markings. Then, two different masked graders (AB + IM) evaluated the overlays for presence of retinal displacement. 16 control eyes following RRD repair with detected retinal displacement on FAF imaging assessed sensitivity and specificity of the technique.
RESULTS: 94% of overlays were found to be well aligned (62/66). 11 cases exhibited errors on flipping view analysis (choroidal/ONH misalignment). Those 11 cases had a significantly higher rate of retinal displacement (false positives) compared to cases without errors (8/11,72% Vs 54/55,98%,P = 0.001). Sensitivity and specificity of the overlay technique for detecting retinal displacement considering only adequate flipping view cases (n = 55) were calculated as 100% and 98%, respectively.
CONCLUSIONS: IR overlay emerges as a reliable and valid method for detecting retinal displacement, exhibiting excellent sensitivity and specificity.

OBJECTIVE: To compare the postoperative retinal displacement by optical coherence tomography (OCT) in idiopathic epiretinal membranes (iERM) and diabetic epiretinal membranes (dERM).
METHODS: This retrospective study included 36 iERM and 22 dERM cases. In cross-sectional OCT images (B-scan) the presence of foveal pit, subfoveal fluid, cotton ball sign (CBS), intraretinal cystic changes (ICC), disorganization of retinal inner layers (DRILs) and ectopic inner foveal layer (EIFL) were recorded. Central macular thickness (CMT) and EIFL thicknesses were calculated. Retinal displacement was quantified using infrared image of OCT approach consisting of the fovea to disc margin, interarcade distance and perimacular distances.
RESULTS: The presence of subfoveal fluid (p = 0.014) and DRIL (p = 0.02) was significantly higher in the dERM group. CMT decreased significantly in both groups (p˂0.001). The EIFL was significantly thicker in the iERM group compared to the dERM group (p = 0.049), and it decreased significantly in the iERM group postoperatively. In the iERM group, while the fovea-disc margin distance decreased, the interarcade and perimacular distance increased significantly (p˂0.001). In the dERM group, the disc-fovea distance change was not significant (p = 0.082). Significant visual improvement was achieved with vitrectomy in both groups (p˂0.001). In the dERM group, the presence of DRIL was associated with lower pre and post-op visual acuity (VA) (r = 0.596 and p = 0.004 for pre-operative and r = 0.567 and p = 0.007 for post-operative).
CONCLUSIONS: Significant retinal displacement occurs after vitrectomy in both iERM and dERM. The low VA in the dERM group may be related to the presence of DRILs.

BACKGROUND: Few large randomized controlled trials provide strong evidence to guide surgical repair of primary rhegmatogenous retinal detachment (RRD) repair. The purpose of this factorial, single-blind, randomized controlled trial is to analyze and compare the surgical outcomes, functional visual outcomes, complications, and quality of life associated with RRD repair using (A) pars plana vitrectomy only (PPV) or PPV with scleral buckle (PPV-SB) and (B) sulfur hexafluoride gas (SF6) or perfluoropropane gas (C3F8) tamponade.
METHODS: Eligible patients with moderately complex RRD will be randomized 1:1 to PPV or PPV-SB and 1:1 to SF6 or C3F8 gas tamponade. Approximately 560 patients will be recruited to be able to detect a difference of around 10% in SSAS rate between the groups. Patients will be followed using multimodal imaging and quality of life questionnaires after the surgical repair until 1 year postoperative. The primary outcome will be a single-surgery anatomic success (SSAS), defined as the absence of reoperation for recurrent RRD in the operating room. Secondary outcomes will be pinhole visual acuity (PHVA) at 8-10 weeks and 6 months, final best-corrected visual acuity (BCVA), final retina status (i.e., attached or detached), time to onset of RRD recurrence, severity and number of complications, and questionnaire results.
CONCLUSIONS: This will be the first 2 × 2 factorial RCT examining repair techniques in primary RRD. It will also be the first RCT to compare gas tamponade between the two most common agents. Notably, it will be adequately powered to detect a clinically significant effect size. The use of multimodal imaging will also be a novel aspect of this study, allowing us to compare head-to-head the impact of adding an SB to the retina\'s recovery after RRD repair and of differing gas tamponades. Until now, the treatment of RRD has been largely guided by pragmatic retrospective cohort studies. There is a lack of strong evidence guiding therapeutic decisions and this trial will address (1) whether supplemental SB is justified and (2) whether longer duration gas tamponade with C3F8 is necessary.
BACKGROUND: ClinicalTrials.gov NCT05863312. Registered on 18 May 2023.

UNASSIGNED: To analyse the differences between 30° blue autofluorescence (BAF30), 55° blue autofluorescence (BAF55) and 200° green Ultra-Wide Field autofluorescence (UWF200) imaging to detect retinal displacement (RD) after vitrectomy surgery for rhegmatogenous retinal detachment (RRD).
UNASSIGNED: This cross-sectional study considers forty-nine consecutive patients who underwent RRD surgery in the time period 4-8 months previous to image acquisition. The exclusion criteria contemplate previous retinal pathology, under 18-year-olds and non-assessable images in any of the 3 devices. These images were analysed by two masked graders that assessed either the presence or absence of retinal displacement. A third observer reviewed the images that presented discordance.
UNASSIGNED: A total of forty-nine patients were analysed. 7 eyes were excluded due to poor quality in either of the imaging modalities. The final analysis included 42 eyes of forty-two patients with a mean age of 60.3 ​± ​11.9 years. All patients underwent a 3 port 23-gauge pars plana vitrectomy as the technique of choice. Any grade of RD was detectable in 45.2% of images. It was similar between BAF30 and UWF200 (42.9% of eyes). BAF55 showed RD to a lesser extent (38.1%). Agreement index between BAF30 and BAF55 was 0.901, 0.903 between BAF30 and UWF200 and 0.803 between BAF55 and UWF200. Kappa agreement index between graders was 0.775 for BAF30, 0.798 for BAF50 and 0.808 for UWF200 images.
UNASSIGNED: All imaging modalities were able to detect RD after vitrectomy for RRD, with no inferiority of BAF30 and BAF55 over UWF200.

Retinal displacement following the repair of rhegmatogenous retinal detachment (RRD) has been reported in recent studies. It was described as vertical movement of the retinal relative to its original location, as evidenced by retinal vessel printing on fundus autofluorescence imaging. This review reports the current literature on retinal displacement. We conducted an English literature search using Medline, PubMed, Embase, and Web of Science. We have reviewed 22 articles describing the diagnosis, frequency, and possible risk factors for retinal displacement. The reported rate of retinal displacement ranged from 6.4% to 62.8%, and the possible risk factors included the detachment-to-repair time, location and extent of RRD, macula-off RD, presence of subretinal fluid, use of perfluorocarbon, use of tamponade, postoperative facedown positioning, type of RRD repair, and presence of proliferative vitreoretinopathy, especially high grade. This review increases awareness of retinal displacement and its associated visual effects.

To assess the risk of retinal displacement after scleral buckle (SB) versus pars plana vitrectomy with SB (PPV-SB).
Multicenter prospective nonrandomized clinical trial.
The study took place at VitreoRetinal Surgery in Minneapolis, Minnesota, Sankara Nethralaya in Chennai, India, and St. Michael\'s Hospital in Toronto, Canada from July 2019 to February 2022. Patients who underwent successful SB or PPV-SB for fovea-involving rhegmatogenous retinal detachment with gradable postoperative fundus autofluorescence (FAF) imaging were included in the final analysis. Two masked graders assessed FAF images 3 months postoperatively. Metamorphopsia and aniseikonia were assessed with M-CHARTs and the New Aniseikonia Test, respectively. The primary outcome was the proportion of patients with retinal displacement detected with retinal vessel printings on FAF in SB versus PPV-SB.
Ninety-one eyes were included in this study, of which 46.2% (42 of 91) had SB and 53.8% (49 of 91) underwent PPV-SB. Three months postoperatively, 16.7% (7 of 42) in the SB group and 38.8% (19 of 49) in the PPV-SB group had evidence of retinal displacement (difference = 22.1%; odds ratio = 3.2; 95% confidence interval [CI], 1.2-8.6; P = 0.02) on FAF. The statistical significance of this association increased after adjustment for extent of retinal detachment, baseline logarithm of the minimum angle of resolution, lens status, and sex in a multivariate regression analysis (P = 0.01). Retinal displacement was detected in 22.5% (6 of 27) of patients in the SB group with external subretinal fluid drainage and 6.7% (1 of 15) of patients without external drainage (difference = 15.8%; odds ratio = 4.0; 95% CI, 0.4-36.9; P = 0.19). Mean vertical metamorphopsia, horizontal metamorphopsia (MH), and aniseikonia were similar between patients in the SB and PPV-SB groups. There was a trend to worse MH in patients with retinal displacement versus those without retinal displacement (P = 0.067).
Scleral buckle is associated with less retinal displacement compared with PPV-SB, indicating that traditional PPV techniques cause retinal displacement. There is a trend toward increased risk of retinal displacement in SB eyes that underwent external drainage compared with SB eyes without drainage, which is consistent with our understanding that the iatrogenic movement of subretinal fluid, such as that which occurs intraoperatively during external drainage with SB, may induce retinal stretch and displacement if the retina is then fixed in the stretched position. There was a trend to worse MH at 3 months in patients with retinal displacement.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.

BACKGROUND: Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair.
METHODS: We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1.
RESULTS: PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2.25-5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = - 0.58, 95% CI = - 1.16 to 0.00) and post-op (SMD = - 0.45, 95% CI = - 0.60 to - 0.30) LogMAR, the improvement in visual acuity after surgery was higher in PPV patients (SMD = 0.49, 95% CI = - 0.15 to 1.13).
CONCLUSIONS: The success rate of PnR was higher in studies published after 2015 compared to previous studies (82% vs. 59%). Cataract formation and surgery were significantly higher in the PPV arm, while the occurrence of new retinal tears was more frequent in the PnR group. PnR can be used as the primary procedure for RRD repair in selected cases. However, we propose some modifications to the PIVOT criteria, e.g., the exclusion of cases presenting with several risk factors of poor outcomes.

暂无摘要。

The management of rhegmatogenous retinal detachment has rapidly evolved over recent decades. A range of surgical techniques exist, all of which can achieve retinal reattachment in most cases. In recent years there have also been vast technical advances in retinal imaging that have introduced novel ways of visualizing and studying the retinal macro and microstructural anatomy following retinal detachment repair. Recent clinical trial data demonstrates that functional and patient-reported outcomes of retinal reattachment differ with surgical technique, accompanied by differences in anatomic biomarkers of retinal recovery or \'integrity\'. We discuss recent insights into the physiology of retinal reattachment gleaned from multimodal imaging, which shed light on the pathophysiology of various post-operative anatomic abnormalities. The ideal scenario is to achieve retinal reattachment as soon as possible, without retinal displacement, outer retinal folds or discontinuity of the external limiting membrane, ellipsoid zone and interdigitation zone, with an intact foveal bulge. To this end, we present an in-depth contemporary account of current concepts and mechanisms involved during retinal reattachment surgery, supported by clinical data and mathematical modelling, awareness of which can help the vitreoretinal surgeon achieve better post-operative outcomes. In this review we substantiate the case for a paradigm shift in rhegmatogenous retinal detachment repair; beyond the emphasis on single-operation reattachment rates, and instead striving to maximize functional outcomes using minimally invasive techniques. This can only be achieved if vitreoretinal surgeons embrace all of the available techniques, with individualized selection of surgical approach and the resolute goal of optimizing the \'integrity\' of retinal reattachment.

OBJECTIVE: Rhegmatogenous retinal detachment (RRD) repair with silicone oil (SO) tamponade has been observed to cause less retinal displacement than gas tamponade. Here, we assessed the mechanism and theoretical extent of retinal displacement in SO versus air tamponade in pars plana vitrectomy (PPV).
METHODS: Computer simulation model.
METHODS: Tamponade scale and subretinal scale simulation models previously developed were used to assess the physical forces, fluid dynamics and retinal deformations in SO versus air PPV.
RESULTS: When comparing a SO tamponade and an air tamponade occupying 93% of the ocular cavity, the SO tamponade has a Bond number that is an order of magnitude smaller and has a much lower contact angle (99° versus 125°) and contact pressure (0.0230 versus 1.44 mmHg). With a greater contact area and contact pressure, an air tamponade squeezes subretinal fluid away from contact points, displacing the retina by a maximum length of approximately 700 μm in our model. In contrast, for a SO tamponade, the contact pressure is much lower with a very small magnitude of retinal displacement (~ 50 μm).
CONCLUSIONS: We showed that SO tamponade leads to significantly less retinal displacement than air tamponades. Although we do not recommend the routine use of primary SO because of its several disadvantages compared with gas, our findings can be further utilized to develop novel tamponade agents that minimize the risk of retinal displacement following RRD repair.