We read with interest the report by Pandya et al.1 of five patients with unintentional macular translocation following retinal detachment repair. Of note, symptoms of vertical deviation were only noted in patients 3, 4 and 5 despite retinal displacement in all five patients, as evidenced by fundus autofluorescence imaging. This is despite patients 1 and 2 having good postoperative macular function (best-corrected visual acuities of 6/6 and 6/12, respectively). It would be interesting to know what the vision was in the fellow eyes and if vertical fusion range was examined to help consider why only some of their subjects were symptomatic.
It is also noteworthy, particularly in patients 1, 2 and 5, that the extent of displacement is non-uniform within the macula. This has been our experience as well, and is in keeping with previous findings that the extent of dysmetropsia (change in image size) is non-uniform in symptomatic patients following retinal detachment repair.2 Following the work of Shiragami et al.,3 we have been monitoring fundus autofluorescence findings in a series of retinal detachment patients. Our findings, to date, indeed confirm that the displacement is typically non-uniform, with evidence of retinal stretch rather than simply a uniform shift in position. In keeping with a non-uniform shift, we have found that many of our symptomatic patients have only been partially improved with prismatic correction. We wonder if this has been the experience of the authors as well.
Finally, the authors suggest that the displacement found could be because of the effect of gravity in upright patients following surgery, and propose face-down positioning instead. It would be helpful to know how these five patients were positioned following surgery. If the face-down positioning is not perfect, or results in pooling of fluid at the macula rather than drainage peripherally,4 tangential stretch forces could be exerted on the macula itself with face-down positioning.