Retinal folds through the macula

In a series of 137 consecutive conventional primary retinal detachment repairs we postoperatively found retinal folds through the macula in four cases (2.8%). All four patients had presented with an acute, bullous, superior detachment, and had been treated with an encircling band, drainage of subretinal fluid, injection of an air/gas mixture, cryocoagulation, and a radial buckle to close the largest retinal tear. Redundant retina (created by the encircling band and possibly by stretching in the bullous detachment) became folded either by compression by the gas-bubble in the recumbent patient, or by a steam roller action of the bubble when the patient sat up. In acute bullous detachments, we try to avoid this complication by using an air/gas bubble which is not greater than necessary to tampon the retinal break, and by positioning the patient in such a way that residual subretinal fluid is pressed away from the posterior pole.