title: Evolution of outer retinal folds occurring after vitrectomy for retinal detachment repair.
abstract: OBJECTIVE
  To assess the evolution of outer retinal folds (ORFs) occurring after repair of rhegmatogenous retinal detachment (RRD) using spectral domain-optical coherence tomography (sd-OCT) and fundus autofluorescence (FAF), and to discuss their pathogenesis.
  
  
  METHODS
  Twenty patients were operated on with 25-gauge pars plana vitrectomy and 20% sulfur hexafluoride gas injection for primary macula-off RRD repair and were followed prospectively. Sd-OCT and FAF images were recorded at 1, 3 and 6 months postoperatively.
  
  
  RESULTS
  ORFs appeared on sd-OCT as hyperreflective lesions consisting of folded inner segment/outer segment of photoreceptors band and external limiting membrane band. Corresponding lines of increased or decreased autofluorescence were observed on FAF. Over the follow-up, the thick hypoautofluorescent lines progressively evolved to thick hyperautofluorescent lines and to thin hyperautofluorescent lines and eventually disappeared. Concomitantly, OCT scans revealed that the corresponding hyperreflective lesions decreased in number, height, and size. In six cases FAF assessment at month 6 was precluded by cataract development.
  
  
  CONCLUSIONS
  ORFS tend to resolve spontaneously within a few months from operation leaving no or subtle abnormalities at the level of the outer retinal layers. OCT is superior to FAF to follow the evolution of orfs in phakic eyes. The following factors might be involved in ORFS pathogenesis: structural changes occurring in the detached retina, residual pockets of subretinal fluid after retinal reattachment, intravitreal gas, unintentional retinal translocation, and intraoperative or perioperative hypotony.
authors.affiliation: Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands. roberto.dellomo@unimol.it
authors.forename: Roberto
authors.initials: R
authors.lastname: dell'Omo
authors.forename: H Stevie
authors.initials: HS
authors.lastname: Tan
authors.forename: Reinier O
authors.initials: RO
authors.lastname: Schlingemann
authors.forename: Heico M
authors.initials: HM
authors.lastname: Bijl
authors.forename: Sarit Y
authors.initials: SY
authors.lastname: Lesnik Oberstein
authors.forename: Francesco
authors.initials: F
authors.lastname: Barca
authors.forename: Marco
authors.initials: M
authors.lastname: Mura
mesh_terms: D000368:Aged; D058450:Endotamponade; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012075:Remission, Spontaneous; D012163:Retinal Detachment / Q000601:surgery*; D012164:Retinal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D055211:Retinal Photoreceptor Cell Inner Segment / Q000473:pathology*; D055214:Retinal Photoreceptor Cell Outer Segment / Q000473:pathology*; D058471:Subretinal Fluid; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D041623:Tomography, Optical Coherence; D014821:Vitrectomy
chemical_list: D013459:Sulfur Hexafluoride