an asymptomatic 22-year - old female was referred to our clinic with a diagnosis of fundus abnormality left eye ( os ) detected upon preoperative examination prior to refractive surgery . dilated fundus examination os revealed an old , localized retinal detachment with a demarcation line and lattice degeneration , with a retinal hole in the inferior temporal periphery . pigmentary changes were conspicuous , with a convex margin at the attached retina posterior to the demarcation line ( fig . ultrasound biomicroscopic ( ubm 840 ; zeiss - humphrey , jena , germany ) examination of the retinal periphery near the causative retinal hole revealed vitreous fibers both anterior and posterior to the retinal hole ( fig . 1b and 1c ) . no change in retinal lesions was observed over a follow - up period of two years . a 58-year - old male was referred to our clinic with a diagnosis of fundus abnormality od . dilated fundus examination od revealed a pigmented peripheral retinal lesion with convex margin at the 6-o'clock position of the peripheral retina . optical coherence tomographic ( oct ; cirrus , carl zeiss meditec , dublin , ca , usa ) examination revealed that the presumed epiretinal membrane was actually a thickened posterior hyaloid membrane . it was also determined that partial posterior vitreous detachment ( pvd ) had developed only on the temporal side of the fovea ( fig . 2b and 2c ) . the patient underwent a pars plana vitrectomy to relieve macular edema due to vitreous traction . an asymptomatic 38-year - old male was referred to our clinic with a diagnosis of retinal break od , which was incidentally detected when the patient underwent a scleral buckling operation in the fellow eye . dilated fundus examination od revealed a pigment - stippled peripheral retinal lesion with a convex margin from 7-o'clock to 11-o'clock . a two disc - diameter sized horseshoe tear with a rolled edge was noted at the 8-o'clock position of the peripheral retina , within the srrrd lesion . the retinal tear was covered and incompletely sealed by a thin translucent vascularized membrane ( fig . ubm examination showed vitreous fibers and a membranous structure overlying the retinal tear ( fig . 3b and 3c ) . an asymptomatic 22-year - old female was referred to our clinic with a diagnosis of fundus abnormality left eye ( os ) detected upon preoperative examination prior to refractive surgery . dilated fundus examination os revealed an old , localized retinal detachment with a demarcation line and lattice degeneration , with a retinal hole in the inferior temporal periphery . pigmentary changes were conspicuous , with a convex margin at the attached retina posterior to the demarcation line ( fig . ultrasound biomicroscopic ( ubm 840 ; zeiss - humphrey , jena , germany ) examination of the retinal periphery near the causative retinal hole revealed vitreous fibers both anterior and posterior to the retinal hole ( fig . 1b and 1c ) . no change in retinal lesions was observed over a follow - up period of two years . a 58-year - old male was referred to our clinic with a diagnosis of fundus abnormality od . dilated fundus examination od revealed a pigmented peripheral retinal lesion with convex margin at the 6-o'clock position of the peripheral retina . optical coherence tomographic ( oct ; cirrus , carl zeiss meditec , dublin , ca , usa ) examination revealed that the presumed epiretinal membrane was actually a thickened posterior hyaloid membrane . it was also determined that partial posterior vitreous detachment ( pvd ) had developed only on the temporal side of the fovea ( fig . 2b and 2c ) . the patient underwent a pars plana vitrectomy to relieve macular edema due to vitreous traction . an asymptomatic 38-year - old male was referred to our clinic with a diagnosis of retinal break od , which was incidentally detected when the patient underwent a scleral buckling operation in the fellow eye . dilated fundus examination od revealed a pigment - stippled peripheral retinal lesion with a convex margin from 7-o'clock to 11-o'clock . a two disc - diameter sized horseshoe tear with a rolled edge was noted at the 8-o'clock position of the peripheral retina , within the srrrd lesion . the retinal tear was covered and incompletely sealed by a thin translucent vascularized membrane ( fig . ubm examination showed vitreous fibers and a membranous structure overlying the retinal tear ( fig . 3b and 3c ) . findings for all three patients were consistent with srrrd , including retinal pigmentary alterations with convex margin of the retinal lesion . interestingly , ubm examination in case 1 revealed vitreous fibers attached to the retinal hole at both the posterior and anterior margins . oct in case 2 demonstrated that a pvd developed only at the horizontal meridian , suggesting vitreous attachment at the optic disc and elsewhere . thus , it seems most likely that pvd was not present in the inferior retinal periphery , where the srrrd was observed . retinal detachments may develop in the absence of a pvd , as was noted in the retinal detachment due to atrophic holes within lattice degeneration . this finding has been shown to occur in younger patients with myopia . however , the development of retinal detachment in the absence of a pvd is apparently a rare event . based on our observations , we suspect that the developmental mechanisms of srrrd are as follows . initially , both focal vitreoretinal adhesion and vitreoretinal traction induce a retinal break in the peripheral retina in an eye without a complete pvd ( as in cases 2 and 3 ) . this is followed by an influx of liquefied vitreous into the retinal break , constituting the development of retinal detachment . however , the direction of vitreoretinal traction changes to parallel the elevated retinal surface ( as in case 1 ) . eventually , vitreoretinal traction is relieved and the retinal break is closed by vitreous fibers running parallel to the retinal plane . this is especially likely if there is vitreous attachment at the posterior border of the retinal break , as in case 1 . as with the interruption of fluid currents through the subretinal space , srrrd develops , and the thin membrane proliferates over the retinal break ( case 3 ) . proliferative membrane sealing of the retinal break as a form of wound healing response contributes to the induction and/or maintenance of retinal reattachment . we suspect the proliferative membrane results from fibroglial and retinal pigment epithelial hyperplasia . in our current report of three cases with srrrd , retinal breaks causing retinal detachment it is worthy to note that the localization of the retinal break in the eyes that developed srrrd is apparently a rare event . despite an extensive search , a retinal break was not identified in any of the 15 cases in a previous series . results of our current study lend indirect support to the prior contention that srrrd preferentially develops in cases of retinal detachment with a small retinal break . identification of a small causative retinal hole would be difficult once development of srrrd is complete , due to the bridging of thin fibrous tissue over the small retinal hole . in addition , diffuse retinal pigment atrophy and sub- and/or an epiretinal membrane within the extent of srrrd could hinder detection of a small retinal hole . in conclusion , we determined that the incidence of srrrd appears closely related to the absence of a pvd near the retinal break , as well as to membrane proliferation over the retinal break .
this retrospective observational case series on eyes from three patients was done to elucidate the developmental mechanism of spontaneous reattachment of rhegmatogenous retinal detachment ( srrrd ) . 
 the study eyes of each patients showed evidence of retinal break and diffuse retinal pigmentary change . 
 ultrasound biomicroscopic examination revealed vitreous fibers attached to the area around the retinal break . 
 posterior vitreous attachment was confirmed in each eye . 
 a thin fibrovascular membrane incompletely sealing the retinal break was noted in one case . 
 we suggest that the vitreous attachment around the retinal break and the sealing of the break with adjacent vitreous fibers seem to be involved in the developmental mechanism of srrrd .