The clinical importance of retinal displacement in planning retinal detachment repair and evaluating outcomes

Retinal displacement is an occasional yet underrecognized sequela of rhegmatogenous retinal detachment (RRD) repair that can cause postoperative visual distortions and anisekonia. While retinal surgeons strive to achieve single-surgery success, more emphasis and understanding should also be placed on optimizing visual outcomes following RRD repair, including minimizing retinal distortions. This review explores the pathophysiology, clinical manifestations, imaging modalities, risk factors, and preventive strategies associated with retinal displacement.

Retinal displacement is associated with significant visual disturbances - most notably metamorphopsia, aniseikonia, and spatial mislocalization - despite preserved visual acuity. Imaging advances, particularly optical coherence tomography (OCT) overlays and OCT homography, have improved detection over traditional fundus autofluorescence. Risk factors for displacement include macula-off detachments, extensive detachment area, use of a complete intraocular gas fill, and surgical modality, with pneumatic retinopexy and scleral buckling associated with lower displacement rates. Computer modeling has suggested biomechanical forces contributing to displacement.

Retinal displacement significantly affects postoperative visual quality following RRD repair. Although often missed on standard examination, improved imaging and surgical refinement offer opportunities for early detection and prevention. Continued research into the mechanisms and outcomes of displacement is critical for optimizing both anatomical and functional success in retinal detachment surgery.