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BACKGROUND AND OBJECTIVES: Postoperative retinal folds are a rare complication of retinal detachment repair. Folds involving the macula may result in decreased vision, metamorphopsia, and diplopia. There is no consensus on whether symptomatic folds require additional surgery, as both spontaneous regression and permanent vision loss have been described. The authors present three cases of symptomatic macular folds that demonstrated spontaneous resolution and identify key OCT prognostic signs. PATIENTS AND METHODS: The study presented is a retrospective case series. RESULTS: Three patients developed symptomatic postoperative macular folds. Despite funduscopic appearances indistinguishable from full-thickness folds, optical coherence tomography (OCT) imaging revealed that none of the folds involved the full thickness of the retina. All cases demonstrated spontaneous resolution with evidence of visual improvement within 2 months. CONCLUSION: OCT is essential in distinguishing between partial and full-thickness macular folds. The authors propose that partial-thickness folds should be termed "pseudo-folds," which represent a unique entity that has a favorable natural history. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:488-492.].

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PURPOSE: To evaluate the incidence rates of cystoid macular edema (CME) and epiretinal membrane (ERM) formation after uncomplicated primary 23-G and 25-G retinal detachment (RD) repair and to identify risk factors associated with postoperative CME and ERM formation. METHODS: This was a consecutive interventional case series of 587 eyes that underwent one RD repair with 23-G or 25-G pars plana vitrectomy (PPV) with scleral buckling. Epiretinal membrane and CME were confirmed by optical coherence tomography (OCT) and fluorescein angiography (FA). RESULTS: A total of 587 eyes with a mean follow-up of 404 days had incidence rates of 35.1% for ERM and 15.2% for CME. The incidence of ERM after combined PPV and scleral buckling (48.4%) (n = 61) was greater (p<0.0001) compared to that after PPV alone (31.2%) (n = 144). CONCLUSIONS: Epiretinal membrane and CME develop frequently after small-gauge RD repair. Pars plana vitrectomy combined with scleral buckling is associated with a higher incidence of ERM. Patients might benefit from increased use of OCT and FA to help rule out CME/ERM.

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A 70-year-old woman presented with signs of acute-onset endophthalmitis within 24 hours of surgery, with retinal hemorrhages and vascular changes in the absence of pain or significant inflammation. She had undergone uncomplicated 25-gauge pars plana vitrectomy for epiretinal membrane with presenting visual acuity of 20/40- and significant distortion. Vitreous culture revealed Staphylococcus epidermidis. Final visual acuity was no light perception with persistent pain, and the patient ultimately underwent enucleation. Although rarely, acute-onset postoperative endophthalmitis can present as retinal vasculitis with intraretinal hemorrhages and mild inflammation.

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PURPOSE: To evaluate whether patients with macular pucker (epiretinal membrane [ERM]) and good preoperative visual acuity (20/50 or better) benefit from small-gauge pars plana vitrectomy with membrane peeling. METHODS: Retrospective chart review of eyes undergoing small-gauge pars plana vitrectomy for ERM. Inclusion criterion was impaired visual acuity (20/50 or better) due to ERM. Exclusion criteria were preoperative visual acuity of 20/60 or worse, previous surgery (other than uncomplicated cataract surgery), and any documented evidence of macular or corneal disease that would limit visual potential. The main outcome measure was final visual acuity. Secondary outcomes included the role of internal limiting membrane peeling, and the effect of preoperative cystoid macular edema and internal limiting membrane peeling on visual acuity. RESULTS: One hundred and forty eyes met inclusion criteria of which 94% underwent 25-gauge vitrectomy (remainder had 23-gauge). There was a statistically significant improvement in final vision with the mean preoperative visual acuity of 0.305 logMAR (20/40) and 1-year visual acuity of 0.250 logMAR (20/35) (P = 0.0167). Cataract formation in phakic patients had a significant effect on the final visual outcome. Fifty-six of 63 patients (89%) in the phakic cohort developed a visually significant cataract by study end. The mean time to recommendation of cataract surgery was 8.4 months. Thirty-eight eyes (27%) had preoperative cystoid macular edema. Fifty-nine eyes (42%) underwent internal limiting membrane peeling. Neither one of these secondary outcome measures had a significant effect on the final visual outcome. CONCLUSION: Pars plana vitrectomy is both efficacious and safe an option for patients with ERMs and good preoperative vision. Eyes with an ERM and vision 20/50 or better had a statistically significant improvement in the final visual outcome after small-gauge pars plana vitrectomy surgery. As with large-gauge vitrectomy, cataract formation occurred in most phakic eyes within the first year after surgery.

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BACKGROUND AND OBJECTIVE: To identify rates and potential risk factors for epiretinal membrane (ERM) and for membrane peel (MP) after 23- or 25-gauge repair and to compare outcomes for eyes with ERM that underwent MP versus observation. PATIENTS AND METHODS: Review of 587 eyes with ERM after retinal detachment repair. Patients who developed ERM either underwent pars plana vitrectomy (PPV) and MP or were observed. RESULTS: Preoperatively, the PPV and MP group had a mean best corrected visual acuity (BCVA) of 20/100, compared to 20/40 for the observation group (P < .001). The PPV and MP group had a higher mean central subfield mean thickness (CSMT) (414 µm vs 281 µm). In the PPV and MP group, mean BCVA was 20/100 preoperatively and 20/50 postoperatively (P < .01). Mean CSMT was 397.5 µm preoperatively and 282.6 µm postoperatively (P < .01). CONCLUSION: ERM is common after 23- or 25-gauge PPV. PPV and MP can improve BCVA and decrease CSMT.

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