13.7 Macular Folds

Macular retinal folds can occur following any retinal detachment surgery and are considered a result of residual sub-retinal fluid (SRF) and incomplete positioning (Figure 13.7.1 and Figure 13.7.2). Folds are probably caused by accumulation of SRF in a gravity-dependent position. Risk factors include superior bullous detachment, macula off detachment where drainage has occurred from the break and residual SRF remains, circumferential buckles and from slippage in giant retinal tears.[1,2,3] Non-foveal folds probably have little clinical significance. When macular retinal folds are observed a re-operation should be scheduled as soon as practicable to unfold the retina as outer retinal denegation occurs as early as 1 week after detachment. Foveal folds are usually associated with poor vision and do not improve spontaneously, but the visual improvement can be significant following successful unfolding. While surgery can sometimes be successful in resolving a macular fold, the best practice is to avoid them by performing complete drainage in cases at higher risk of fold (with either perfluoro-n-octane or a posterior drainage retinotomy) and in rapidly positioning the patient in the face down position as soon as surgery has been completed (Figure 13.7.3 and Figure 13.7.4).