After successful retinal reattachment, up to 30% of patients are complaining about metamorphopsia postoperatively. Thus, metamorphopsia is one of the most common symptoms after retinaldetachment repair, especially in macula-off RRD. Distorted vision postoperatively can lead to dissatisfaction despite successful reattachment.
PD Dr Guber showed in his first study, where from five tested factors, only retinal shift and macular folds were significantly associated with metamorphopsia postoperatively. However, macular folds and retinal shift were highly associated with each other. Epiretinal membrane in early stage is uncommon.
The retina is shifting downward under the influence of gravity immediately after surgery because of a small amount of leftover subretinal fluid and the use of gas as an intraocular tamponade. Therefore, by reducing the amount of subretinal fluid you can minimize the risk of postopertive shift. In his second study he showed that the use of heavy liquid during procedure can significantly reduce the risk of retinal shift postoperatively. Postoperative Posturing might have an impact on retinal shift as well. The PostRD Trial showed that postoperative face down position is superior over the support-the-break position in terms of reducing the risk of retinal displacement. However there are some good news, the amount of retinal shift decreases over a one year follow up, but epiretinal membrane formation accounts for the most metamorphopsia in the late postoperative periode.
