A possible strategic role of air during pars plana vitrectomy for macula-involving rhegmatogenous retinal detachment

Postoperative complications after successful primary rhegmatogenous retinal detachment repair

BACKGROUND

To evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD).

METHODS

Retrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD "pending foveal detachment" subgroup.

RESULTS

Sixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6).

CONCLUSIONS

The risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.

Metamorphopsia and Morphological Changes in the Macula after Scleral Buckling Surgery for Macula-Off Rhegmatogenous Retinal Detachment

Purpose

To observe the changes in metamorphopsia after scleral buckling (SB) surgery for macula-off rhegmatogenous retinal detachment (RRD) and its association with morphological changes in the macula.

Methods

This prospective study included 20 eyes of 20 patients. Before surgery and 1, 3, 6, and 12 months after surgery, metamorphopsia measured by M-charts and best-corrected visual acuity (BCVA) and macular microstructures assessed using optical coherence tomography were recorded.

Results

Both the vertical and horizontal M-scores improved significantly after SB surgery. BCVA also improved gradually. The mean M-score in the eyes with a continuous external limiting membrane (ELM) was smaller than that in the eyes with a disrupted ELM (P=0.008). Preoperative and postoperative BCVA did not correlate with the mean M-score at any time point. The other studied parameters, namely, the duration of RRD, the height of retinal detachment, central foveal thickness, inner nuclear layer thickness, and continuation of the ellipsoid zone, were also not relevant.

Conclusions

The continuation of the ELM may be a critical factor in determining the severity of metamorphopsia after SB surgery for macula-off RRD.