Improvements in visual acuity following reattachment surgery may be achievable using several different methods. The first would be a reduction in the rate of complications associated with macular dysfunction. These include both macular edema and macular pucker. Both are well-described complications of retinal reattachment surgery as well as other vitreoretinal conditions and may be amenable to pharmacological intervention. Recent reports suggest that intra-vitreal steroids, principally triamcinolone acetonide, and also dexa-methasone in a bioerodable polymer may reduce macular edema associated with several conditions, including diabetic retinopathy, uveitis, and retinal vein occlusion [11,12]. The use of steroids by other routes of administration, including oral and parenteral, may also be of benefit in preventing macular complications, such as pucker .
It may also be possible to improve visual acuity through the enhancement of photoreceptor regeneration in eyes with macula-off retinal detachments. Processes governing photoreceptor renewal and normal alignment of the outer segments following retinal reattachment are still poorly understood, and the potential use of pharmacological agents and, specifically, cytokines may be a promising avenue to restoring visual function above and beyond that which might be expected simply by reattachment of the macula, particularly in eyes with more longstanding retinal detachments. To date, there are no well-defined or well-controlled clinical trials that would suggest such an agent is available or on the near horizon, but it is anticipated that in the future this approach may be feasible.
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