Vector-based quantification of macular displacement after rhegmatogenous retinal detachment surgery: Correlation with surgical technique and metamorphopsia severity

BACKGROUND: Rhegmatogenous retinal detachment (RRD) repair achieves high anatomical success, yet postoperative metamorphopsia remains a frequent cause of visual dissatisfaction. Retinal displacement on fundus autofluorescence has been implicated, but its magnitude and direction have not been adequately quantified with standardized vector-based methods. DESIGN: Single-center, prospective, observational study. PURPOSE: To quantify macular displacement after primary macula-off RRD repair using macula-centered vector analysis and to examine its relationship with surgical technique and postoperative metamorphopsia. METHODS: A total of 118 eyes with primary macula-off RRD underwent pars plana vitrectomy with silicone oil (PPV-SiO), pars plana vitrectomy with gas (PPV-Gas), pneumatic retinopexy (PnR), or scleral buckling (SB). Six-month fundus autofluorescence images were analyzed with a standardized vector-based method to determine composite displacement magnitude and direction across four macular quadrants. The best-corrected visual acuity (BCVA) was recorded preoperatively and at 1, 3, and 6 months; metamorphopsia was assessed with M-CHARTS. Covariance analyses adjusted for age, lens status, proliferative vitreoretinopathy stage, and high myopia. RESULTS: Displacement differed significantly by surgical technique. PPV-Gas showed the greatest composite displacement (603.59 ± 343.29 µm), followed by SB (309.05 ± 341.79 µm), PPV-SiO (241.71 ± 224.89 µm), and PnR (133.69 ± 78.04 µm) ( P = 0.0001). Composite vector angle also differed among groups ( P = 0.009). BCVA improved significantly in all groups, with the best 6-month BCVA in PnR (0.17 ± 0.17 logMAR). Mean metamorphopsia scores differed between groups but were not significantly associated with displacement presence, magnitude, or direction. CONCLUSION: Macular displacement after RRD repair is strongly influenced by surgical technique and is greatest after PPV-Gas; however, displacement metrics did not predict postoperative metamorphopsia in this cohort.