Spectral-domain optical coherence tomography of a macular fold after retinal detachment repair

Purpose: We report a case with a dry macular fold after retinal detachment repair using spectral-domain optical coherence tomography images (SD-OCT) to evaluate details of the retinal architecture before and after surgical management. Methods: A 62-year-old man diagnosed with macula-threatening rhegmatogenous retinal detachment underwent primary vitrectomy with an encircling sclera buckle. On post-operative day 5, he was noted to have developed a juxtafoveal retinal fold. SD-OCT was used to image the retinal fold and documented apposition of the retinal layers and discontinuity within the photoreceptor layer in the vicinity of the retinal fold. Results: The attempts to detach and unfold the retina appeared minimally successful intraoperatively. However, as the gas bubble decreased, the retinal fold was noted to have resolved. Repeat SD-OCT documented flattening of the retinal fold with a well-preserved photoreceptor layer. Conclusion: This outcome suggests the possibility of delayed postoperative success in flattening a retinal fold despite resistance to manipulation and failed attempts during the course of the surgery. To our knowledge, this is the first report that demonstrates this finding within the macular architecture after retinal detachment surgery in vivo using spectral-domain optical coherence tomography. These findings may have an important role in management of these cases and may become prognostic indicators based on the alterations in retinal anatomy demonstrated by high-resolution imaging.