We read the article by Larrison et al1 in the May 1993 issue of the Archives with interest and would like to emphasize aspects of subretinal fluid (SRF) drainage and postoperative positioning that substantially eliminate posterior retinal folds.
Most of the folds described resulted from retinal distortion by large bubbles along the posterior margin of subtotal detachments, which were incompletely drained. Either a smaller bubble or more complete transvitreal drainage of SRF, as opposed to transscleral drainage, will prevent this disproportion between the size of the bubble and the amount of residual SRF. We have found that interrupting the fluid-gas exchange as soon as the bubble has closed the break(s) to displace SRF into the vitreous space with scleral depression is almost always preferable to transscleral drainage in cases of this kind. Of course, more complete drainage via the retinal break using a flexible cannula, or by means of
Avins LR, Krummenacher TK, Rothman RJ. Posterior Retinal Folds Following Vitreoretinal Surgery. Arch Ophthalmol. 1994;112(4):447-448. doi:10.1001/archopht.1994.01090160021005