Grading retinal displacement after retinal detachment repair: a prospective study linking displacement grade and visual outcome

Background: To evaluate the impact of surgical technique, preoperative findings, and the degree of retinal displacement on visual outcomes in patients undergoing repair for rhegmatogenous retinal detachment (RRD). Methods: In this prospective cohort study, all consecutive patients with RRD treated at Sheba Medical Center between March 2021 and March 2022 were included. Data on surgical techniques, visual acuity (VA), preoperative posterior vitreous detachment (PVD), and postoperative imaging were collected. Retinal displacement was graded based on fundus autofluorescence and correlated with visual outcomes. Results: A total of 128 eyes from 128 patients (mean age 56.7 ± 15.4 years) were analyzed. Pars plana vitrectomy (PPV) was the most common procedure (79.9%), followed by scleral buckle (SB, 18.8%) and pneumatic retinopexy (2.3%). Significant improvement in VA was observed across all surgical groups. Retinal displacement was more frequent following PPV (68%) compared to SB (16%). Higher displacement grades (2–3) were associated with significantly worse final VA (p = 0.024). The presence of preoperative PVD positively correlated with surgical success in the PPV group (p = 0.003). Early postoperative signs of displacement included retinal folds and photoreceptor changes. Conclusions: Preoperative PVD status is a significant predictor of surgical success in PPV-treated RRD. Grading of retinal displacement offers a practical tool to assess its functional impact, with higher grades correlating with worse visual outcomes. Identifying risk factors for visually significant displacement may improve surgical decision-making and patient prognosis.