“Integrity” Assessment Following Rhegmatogenous Retinal Detachment Repair

We commend Mahmoudzadeh et al. 1 for assessing "integrity" following rhegmatogenous retinal detachment (RRD) repair, rather than solely focusing on the primary anatomic reattachment rate, which has historically been prioritized in the literature.Achieving primary anatomic reattachment with the retina stretched and displaced is clearly not an ideal outcome.In their single-center series (194 RRD eyes), 12.9% of all eyes demonstrated retinal displacement, as evidenced by retinal vessel printings (RVPs) on fundus autofluorescence (FAF).Consistent with the literature, retinal displacement was more prevalent in eyes that underwent pars plana vitrectomy (PPV).The reported rate of retinal displacement post-PPV (15.5%) in this work is relatively low compared to previous literature.A systematic review identified several studies from around the world, including Italy, Spain, Japan, and the United Kingdom, which used rigorous imaging protocols and reported retinal displacement rates of approximately 50% post-PPV, as evidenced by RVPs on FAF. 2 Additionally, in the multicenter ALIGN studies, we found that 51% of RRD eyes demonstrated retinal displacement on FAF post-PPV, 3 39% of eyes post-PPV with scleral buckle (SB), and 17% of eyes post-SB in fovea-off cases.4 Displacement rates are typically lower in fovea-on RRDs, and Mahmoudzadeh et al. included both fovea-on and fovea-off cases.However, this alone would not account for the low rates of displacement reported.Recent evidence from overlaying optical coherence tomography infrared images before the occurrence of RRD and after RRD repair has raised concerns about the sensitivity of FAF imaging in detecting retinal displacement.5 The high false-negative rate of FAF imaging underscores the need for additional imaging modalities.6 Indeed, this infrared homography case series demonstrated that all patients who underwent PPV for RRD had retinal displacement.5 We value the authors' work and suggest that the relatively low rate of retinal displacement post-PPV reported here and in other studies may have resulted from detection limitations associated with FAF imaging. 2 Factors such as media opacity, focus, and grading methodology can significantly impact the assessment of retinal displacement on FAF, potentially leading to false negatives.This complicates the assessment of differences in functional outcomes.We advocate for the development and validation of novel methods to improve the sensitivity and specificity of detecting retinal displacement, and for the standardization of methods for reporting its presence or absence.Only then can we adequately assess differences in functional outcomes between patients with and without retinal displacement and better understand how variations in surgical techniques influence outcomes.

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