Long-Term Follow-Up of the Postoperative Macular Fold following the Vitreoretinal Surgery with Air Tamponade

A 64-year-old male who had a macula-on superior bullous retinal detachment in OD underwent scleral buckling, 20-gauge-pars plana vitrectomy, internal drainage of subretinal fluid with perfluorocarbon fluid, 360° endolaser and perflourocarbon-fluid-air exchange surgery. Patient sat upright immediately after the surgery for the night. At the first postoperative morning although the retina was attached, there was a macular fold extending toward the temporal retinal periphery. Patient denied further surgery. During the follow-up, retinal fold gradually became less visible and it could be noticeable only by fundus autoflorescence imaging at the sixth postoperative year with a subtle epiretinal membrane formation on the optical coherence tomographic section. 1. Introduction Retinal fold formation is a rare complication of retinal detachment (RD) surgery and has been described following intravitreal gas injection both with and without scleral buckling elements and with or without vitrectomy. It is thought to result from residual subretinal fluid being sequestered after the retinal break has been closed by intravitreal gas tamponade allowing subretinal fluid to accumulate in a gravity dependent position at the margin of attached and detached retina [1]. It may have a negative impact on visual outcome as histologic evidence demonstrates that the outer retina degeneration occurs as early as one week following the retinal fold formation and continues to worsen at four weeks [2]. We hereby report a case with macular fold that was developed following a successful scleral buckling surgery together with vitrectomy and fluid-air exchange for a bullous macula-on superior rhegmatogenous retinal detachment and describe its natural course over a six-year period. 2. Case Presentation A 64-year-old otherwise healthy man presented with a visual loss in his right eye of three days duration. Slit-lamp examination and intraocular pressure were normal with a clear lens in both eyes. On funduscopy, there was a macula-on superior bullous RD associated with four adjacent tears located at the superior quadrant in OD. The patient underwent encircling with an additional silicone tire extending from 10 to 2 hours in association with 20-gauge-pars plana vitrectomy, internal drainage of subretinal fluid (SRF) using perfluorocarbon liquid, 360° endolaser photocoagulation, and perflourocarbon-fluid-air exchange. Patient sat upright immediately after the surgery for the night. At the first postoperative morning, the retina was attached and the 2/3 of vitreous cavity was full of air. However,