Analysis of Retinal Displacement by Overlay of Infrared Imaging after Pars Plana Vitrectomy for Retinal Detachment Repair: A Multicenter Study.

PURPOSE: To evaluate the prevalence, direction, and characteristics of postoperative retinal displacement after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair using infrared (IR) image overlay technique in a multicenter cohort.

DESIGN

Multicenter retrospective cohort study.

SUBJECTS: Patients undergoing PPV for primary macula-involving RRD with available high-quality predetachment and postoperative IR imaging.

METHODS

Pre-RRD and post-RRD repair IR images were overlaid using a validated overlay technique that aligns deep retinal structures to assess displacement of the superficial retinal vessels. Retinal displacement was graded by masked readers based on magnitude (mild, moderate, or severe), direction, and displacement vectors. Macular stretch or compression was assessed vertically and horizontally. Associations between clinical, surgical, and imaging variables and displacement outcomes were analyzed.

MAIN OUTCOME MEASURES: Prevalence, magnitude, direction, and vector characteristics of retinal displacement after PPV for RRD repair.

RESULTS

Seventy eyes of 70 patients met the inclusion criteria. Postoperative retinal displacement was detected in 97% of eyes. All eyes with fovea-off RRD demonstrated retinal displacement, whereas 82% of fovea-on cases were displaced. Inferior displacement was the predominant direction (80%), most commonly oriented inferotemporally. Displacement severity was graded as mild, moderate, and severe in 34%, 42%, and 23% of cases, respectively. Silicon oil tamponade was associated with reduced displacement severity and a higher rate of superior displacement compared with gas tamponade (P < 0.01). Intraoperative perfluorocarbon liquid use was significantly associated with horizontal macular stretch (P = 0.04). The extent of retinal detachment was the primary predictor of displacement severity on multivariable analysis.

CONCLUSIONS

Retinal displacement occurs in nearly all eyes after PPV for macula-involving RRD repair when assessed using overlay-based IR imaging, at rates substantially higher than previously reported using fundus autofluorescence. Perfluorocarbon liquid was associated with temporal macular stretch. Surgical factors, particularly tamponade choices, influence the severity and pattern of displacement.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.