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A. V. Chappelow, C. Sonnie, J. E. Sears; Prompt Repair of Postoperative Macular Fold Yields Favorable Visual and Anatomic Outcomes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4451.
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Foveomacular fold as a complication following scleral buckling surgery may lead to outer retinal degeneration and permanent visual loss. Folds can occur even when a scleral buckle is accompanied by vitrectomy and gas insufflation. Herein we report anatomic and visual outcomes following surgical repair of postoperative macular fold.
This is a retrospective case study of patients who underwent repair of a macular fold that occurred as a complication of scleral buckling procedure. Ophthalmic findings, surgical technique, complications, and anatomic and visual outcomes were reviewed for 5 consecutive patients who underwent macular fold repair between 2005 and 2007.
The initial retinal detachment repair involved scleral buckle alone in 1 patient and scleral buckle/vitrectomy/gas insufflation in 4 patients. The time from initial surgery to fold repair ranged from 13 to 18 days (mean = 15 days). In all cases, postoperative macular fold was repaired by three-port vitrectomy, subretinal balanced salt (BSS) injection using a 39 gauge cannula through a self sealing retinotomy superior and inferior to the fold in an extramacular location, followed by air-fluid exchange if the fold did not open. Once the fold was relaxed, PFO was used under fluid to drive subretinal BSS out of a peripheral break (if open) or a superior retinotomy on the scleral buckle. Endolaser and PFO-air-SF6 exchange was then performed. Best-corrected visual acuity improved in all cases (preoperative visual acuity range: 1 logMAR - 2.3 logMAR, mean = 1.36 logMAR; postoperative range: 0 logMAR - 1.82 logMAR, mean = 0.32 logMAR). Resolution of macular fold and maintenance of retinal reattachment was achieved in all cases. Mean follow-up was 8 months (range 3 - 15 months).
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