Congenital Retinal Displacement: Treatment Options
For a congenitally displaced retina affecting visual acuity from birth, surgical detachment and reattachment is not a viable treatment option, as this approach is designed for acquired retinal detachments with breaks or traction—not for congenital anatomical malpositions of the retina. 1, 2
Why Standard Retinal Detachment Surgery Does Not Apply
Rhegmatogenous retinal detachment surgery (scleral buckling, vitrectomy, or pneumatic retinopexy) is specifically designed to treat retinal detachments caused by retinal breaks that allow fluid to separate the neurosensory retina from the retinal pigment epithelium (RPE). 2, 3
Tractional retinal detachment surgery addresses membranes that contract and pull the retina away from the RPE, typically in conditions like proliferative diabetic retinopathy or following acute retinal necrosis. 2, 4
A congenitally displaced retina represents a developmental anatomical variant where the retina developed in an abnormal position from birth—there is no "detachment" to repair, but rather a structural malposition that has been present since ocular development. 1
The Critical Distinction: Ectopic Macula vs. Retinal Detachment
Ectopic macula (displaced fovea) is a congenital condition most commonly seen in retinopathy of prematurity, where the macula develops in a temporally or nasally displaced position, creating a positive or negative angle kappa that can simulate strabismus. 1
This anatomical displacement cannot be corrected by "detaching and reattaching" the retina, as the retina is already attached—it simply developed in the wrong location during embryogenesis. 1
Macular translocation surgery is an experimental procedure designed to move the sensory retina from damaged RPE to intact RPE in age-related macular degeneration, but this is not applicable to congenital displacement and carries significant risks with limited evidence for efficacy even in its intended use. 1
What Can Be Done: Optimizing Visual Function
Refractive Correction
Perform cycloplegic refraction to identify any underlying refractive error (hyperopia, myopia, or astigmatism) that may be contributing to decreased visual acuity, as correcting even small refractive errors can significantly improve functional vision. 1, 5
Prescribe appropriate spectacle correction based on the cycloplegic refraction findings, as this represents the most effective intervention for maximizing visual potential in congenital retinal abnormalities. 1
Amblyopia Management (If Applicable)
If the patient is still within the critical period for visual development (typically before age 8-10 years), aggressive amblyopia treatment with patching of the better eye may improve visual acuity in the affected eye, though outcomes depend on the severity of the anatomical abnormality. 1
Treatment should be initiated as early as possible to maximize binocular potential and prevent or treat amblyopia, as delayed treatment significantly reduces the likelihood of visual improvement. 1
Comprehensive Evaluation
Complete dilated fundus examination is essential to document the exact nature of the retinal displacement, rule out associated retinal pathology (such as retinal breaks, lattice degeneration, or other peripheral retinal abnormalities), and establish a baseline for future monitoring. 1
Optical coherence tomography (OCT) should be performed to assess macular architecture, measure central retinal thickness, and identify any associated structural abnormalities such as epiretinal membranes or vitreomacular traction that might be amenable to treatment. 1
Important Caveats
No surgical intervention exists to reposition a congenitally displaced retina to its normal anatomical location—the retina cannot simply be "moved" to where it should have developed. 1, 2
Any consideration of experimental surgical approaches (such as macular translocation) would require consultation with a vitreoretinal specialist at a tertiary referral center, understanding that such procedures are not standard of care for congenital displacement and carry substantial risks including vision loss, retinal detachment, and proliferative vitreoretinopathy. 1, 2
Visual prognosis depends entirely on the degree of displacement and whether the fovea developed normally in its abnormal location—if foveal architecture is disrupted, visual potential will be permanently limited regardless of intervention. 1
Regular ophthalmologic follow-up is necessary to monitor for development of secondary complications such as retinal breaks or detachment, particularly if the patient is myopic or has other risk factors. 1, 3