Inner, outer, and full-thickness retinal folds after rhegmatogenous retinal detachment repair: A review

Impact of drainage retinotomy on surgical outcomes of retinal detachment: insights from the Japan-Retinal Detachment Registry

We investigated the impact of drainage retinotomy on the outcome of pars plana vitrectomy for repair of rhegmatogenous retinal detachment (RRD). This study was a retrospective observational multicenter study. All patients were registered with the Japan-Retinal Detachment Registry. We analyzed 1887 eyes with RRD that had undergone vitrectomy and were observed for 6 months between February 2016 and March 2017. We compared the baseline characteristics and postoperative outcomes between eyes with and without drainage retinectomy. We then performed propensity score matching using preoperative findings as covariates to adjust for relevant confounders. Of 3446 eyes, 1887 met the inclusion criteria. Among them, 559 eyes underwent vitrectomy with drainage retinotomy, and 1328 eyes underwent vitrectomy without drainage retinotomy. After propensity score matching, each group comprised 544 eyes. There was no significant difference between the two groups in BCVA at 6 months after vitrectomy (0.181 vs. 0.166, P = 0.23), the primary anatomical success rate (6.3% vs. 4.4%, P = 0.22), or the rate of secondary surgery for ERM within 6 months (1.5% vs. 1.3%, P = 1.0). Drainage retinectomy does not increase the risk of decreased postoperative BCVA, surgical failure, or secondary surgery for ERM within six months outcomes.

Multiple Types Late-Onset Postoperative Retinal Folds following Vitrectomy for Retinal Detachment Repair with Silicone Oil: Morphologic Variability and Optical Coherence Tomography Angiography Features - A Case Report

Introduction

Retinal folds (RFs) may develop following rhegmatogenous retinal detachment (RRD) repair, though it consists an uncommon complication.

Case Presentation

Herein, we present a case of late-onset postoperative outer RFs with aggravating characteristics following vitrectomy with silicone oil (SO) tamponade for RRD repair; early clinical findings, complications, anatomical and functional status during a 12-month follow-up period are described. Retinal imaging by acquiring optical coherence tomography scans and angiograms indicates detailed morphological and angiographic characteristics of the evolution of RFs over time. Our case provides insight into a combination of various types of RFs along with retinal disorganization with appearance in the late postoperative period after RRD repair with SO tamponade.

Conclusion

Our aim was to raise awareness of the pathological processes that may be associated with the development and evolution of RFs after successful RRD repair, indicating that it is critical to accurately diagnose the type of RFs and closely monitor their progression in an attempt to provide prognostication for future visual outcomes.

PREOPERATIVE GAS FOR PARS PLANA VITRECTOMY: A SURGICAL TECHNIQUE FOR REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENTS WITH MULTIPLE, LARGE, OR INFERIOR BREAKS

PURPOSE

To describe the role of preoperative gas for pars plana vitrectomy (PGP) as an adjunct to surgical repair of rhegmatogenous retinal detachment (RRD).

METHODS

This is a retrospective consecutive case series of all rhegmatogenous retinal detachments with multiple breaks in more than one quadrant, large breaks extending greater than one clock hour, and/or inferior breaks requiring PPV, who received intravitreal injection of sulfur hexafluoride (SF 6 ) or perfluoropropane (C 3 F 8 ) 1-2 weeks before PPV between 2016 and 2020 at a tertiary care center.

RESULTS

A total of 109 eyes underwent the PGP technique, 73% of which had macular involvement. The rhegmatogenous retinal detachments on average involved 5.5 (SD 2.1) clock hours with inferior retinal breaks in 51%. Based on clinical examination, subretinal fluid was noted to be dissipated in parts of the detached retina before PPV in 57% of cases. The use of perfluorocarbon heavy liquid or posterior drainage retinotomy was required in 16% of cases. A 95% primary anatomical success rate was achieved over the median 177 (interquartile range 105-526) follow-up days. A final visual acuity of 20/50 or better was achieved in 65%.

CONCLUSION

PGP as an adjunct to PPV may facilitate ease of surgery, as well as anatomical and functional success for rhegmatogenous retinal detachments with multiple, large, and/or inferior breaks.

Intravitreal air tamponade after AAV2 subretinal injection modifies retinal EGFP distribution

The subretinal injection protocol for the only approved retinal gene therapy (voretigene neparvovec-rzyl) includes air tamponade at the end of the procedure, but its effects on the subretinal bleb have not been described. In the present study, we evaluated the distribution of enhanced green fluorescent protein (EGFP) after subretinal injection of AAV2 in non-human primates (NHP) without (group A = 3 eyes) or with (group B = 3 eyes) air tamponade. The retinal expression of EGFP was assessed 1 month after subretinal injection with in vivo fundus photographs and fundus autofluorescence. In group A (without air), EGFP expression was limited to the area of the initial subretinal bleb. In group B (with air), EGFP was expressed in a much wider area. These data show that the buoyant force of air on the retina causes a wide subretinal diffusion of vector, away from the injection site. In the present paper, we discuss the beneficial and deleterious clinical effects of this finding. Whereas subretinal injection is likely to become more common with the coming of new gene therapies, the effects of air tamponade should be explored further to improve efficacy, reproducibility, and safety of the protocol.

Postoperative positioning regimens in adults who undergo retinal detachment repair: A systematic review

Little is known about the comparative benefit of different positioning regimens in rhegmatogenous retinal detachment (RRD) repair. We compared outcomes of different postoperative posturing regimens following pars plana vitrectomy (PPV). MEDLINE, EMBASE, and Cochrane CENTRAL were searched from 2000 to February 2022 for original studies that compared at least 2 postoperative posturing regimens in adults who underwent PPV for RRD. Seven comparative studies and 703 eyes were included. There were no differences in final visual acuity between posturing regimens. Single-procedure reattachment rates were higher with alternative positioning compared to prone positioning in patients with inferior breaks. Prone and alternative positioning were associated with similar risks of complications. In contrast, prone posturing had a higher risk of neck pain and intraocular pressure elevation than support-the-break, which had a greater risk of retinal displacement, retinal folds, and binocular diplopia. Immediate prone positioning was superior to delayed prone for the risk of retinal displacement. The present review shows that prone positioning was associated with a lower reattachment rate than alternative positioning. There were trade-offs in complications between prone and support-the-break positioning. Retinal displacement could be mitigated when prone positioning is maintained immediately after surgery.

Long-Term Macular Vascular Changes after Primary Rhegmatogenous Retinal Detachment Surgery Resolved with Different Tamponade or Different Surgical Techniques

Background: The aim of this study was to assess long-term macular vascular changes and their correlation with functional recovery in patients successfully treated for Macula-ON and Macula-OFF rhegmatogenous retinal detachment (RRD). Methods: This retrospective observational study included 82 eyes of 82 patients who received primary successful retinal detachment surgery, 33 Macula-ON and 49 Macula-OFF. Superficial and deep capillary plexuses (SCP and DCP) were evaluated by optical coherence tomography angiography (OCTA), and were correlated with visual acuity (VA), surgical technique and tamponade at 12 months after surgery. The fellow eyes were used as controls. Results: At 12-month follow-up, there was a significant decrease in the vessel density (VD) in the SCP in the operated eyes compared to control eyes (p < 0.05) in both the Macula-ON and Macula-OFF groups. Vessel length density (VLD) decrease in SCP was more extended in the Macula-OFF group. No difference in the DCP perfusion parameters was found, compared to controls. Subgroup analysis dependent on the type of surgery or tamponade showed no significant differences of VD and VLD. An inverse correlation was found between the SCP VD and the duration of silicone oil (SO) tamponade (p = 0.039). A significant correlation was observed between parafoveal SCP VD and final best corrected visual acuity (BCVA) (p = 0.028). The multivariate linear regression analysis showed that only the type of tamponade was significantly correlated with the final BCVA in the Macula-ON group (p = 0.004). Conclusions: Our study described long-term perfusion changes in RRD after surgery, with lower SCP VD and VLD in the operated eyes compared to the fellow ones, not influenced by type of surgery or tamponade. The choice of tamponade and SO removal timing may affect functional outcomes, especially in Macula-ON RRD. In conclusion, such functional and perfusion changes can be considered biomarkers that highlight the relevance of careful management of this sight-threatening disease.

Clinical and imaging characteristics of outer retinal folds in eyes with retinitis

Purpose

To describe clinical and imaging characteristics of the outer retinal folds (ORF) in cases of retinitis, retinochoroiditis, and chorioretinitis.

Methods

Retrospective review of retinitis cases with presence of ORFs either at presentation or during follow up.

Results

ORFs were seen adjacent to retinitis lesions in 16 eyes of 14 cases (retinitis post-febrile illness n = 10, toxoplasma retinochoroiditis n = 2, fungal chorioretinitis n = 2) either at presentation (n = 2) or during follow up (n = 14). Optical coherence tomography (OCT) appearance was outer retinal vertical stout lesions involving ellipsoid, external limiting membrane, and outer nuclear layer. All the cases had a presence of past or concurrent subretinal fluid and/or subretinal hyperreflective material when ORF was seen. ORF resolved with variable outer retinal atrophy over a mean period of 2.86 months.

Conclusion

ORF is observed in cases of retinitis with subretinal fluid either at presentation or during resolution. It is not specific to any etiological disease. Differentiation of this sign from vertical outer retinal stripes in viral retinitis on OCT is important to avoid misinterpretation.

[Macular folds after surgical repair of retinal detachment]

The incidence of retinal folds following surgical repair of retinal detachment is underestimated. The extent of retinal folds is variable and can include the complete retina with all layers and an apposition of the photoreceptor outer segments or only partially affect the outer or inner retinal layers. While complete folds can be relatively easily detected by clinical examination, discrete partial folds are sometimes difficult to assess biomicroscopically. In these cases, high-resolution optical coherence tomography (OCT) plays an important role as a tool for differential diagnosis. If macular translocation occurs during the formation of folds, mostly in associated with inferior retinal folds, patients often complain of binocular double vision. A significant reduction of visual acuity and metamorphopsia occur in cases where the folding involves the fovea. In general, retinal folds tend to resolve spontaneously over a prolonged period of follow-up of several months; however, in cases of foveal involvement and corresponding symptoms, a surgical revision can be indicated, although the surgical procedure is not standardized.

Retinal Folds as a Clinical Feature of X-Linked Retinoschisis: A Series of Three Cases

BACKGROUND AND OBJECTIVE

The most common clinical features of X-linked retinoschisis (XLRS) include macular schisis in a spoke wheel pattern and peripheral schisis, though other findings such as vitreous veils, vascular attenuation, and subretinal fibrosis have been described. This is the first report to describe retinal folds as a characteristic feature in patients with XLRS.

PATIENTS AND METHODS

This was a case series of patients presenting to the retina service at Bascom Palmer Eye Institute with genetically confirmed XLRS. Patients included in this report underwent examination under anesthesia with multimodality imaging.

RESULTS

Three patients with XLRS were found to have retinal folds, including a newly characterized "retinal scroll" seen on examination and multimodality imaging.

CONCLUSIONS

The presence of a retinal fold should yield a differential diagnosis that includes XLRS in the correct clinical context. Panel-based genetic testing and multimodal imaging are useful in guiding clinical management. [Ophthalmic Surg Lasers Imaging 2022;53(6):326-331.].

An Essential Role for Alzheimer’s-Linked Amyloid Beta Oligomers in Neurodevelopment: Transient Expression of Multiple Proteoforms during Retina Histogenesis

Human amyloid beta peptide (Aβ) is a brain catabolite that at nanomolar concentrations can form neurotoxic oligomers (AβOs), which are known to accumulate in Alzheimer’s disease. Because a predisposition to form neurotoxins seems surprising, we have investigated whether circumstances might exist where AβO accumulation may in fact be beneficial. Our investigation focused on the embryonic chick retina, which expresses the same Aβ as humans. Using conformation-selective antibodies, immunoblots, mass spectrometry, and fluorescence microscopy, we discovered that AβOs are indeed present in the developing retina, where multiple proteoforms are expressed in a highly regulated cell-specific manner. The expression of the AβO proteoforms was selectively associated with transiently expressed phosphorylated Tau (pTau) proteoforms that, like AβOs, are linked to Alzheimer’s disease (AD). To test whether the AβOs were functional in development, embryos were cultured ex ovo and then injected intravitreally with either a beta-site APP-cleaving enzyme 1 (BACE-1) inhibitor or an AβO-selective antibody to prematurely lower the levels of AβOs. The consequence was disrupted histogenesis resulting in dysplasia resembling that seen in various retina pathologies. We suggest the hypothesis that embryonic AβOs are a new type of short-lived peptidergic hormone with a role in neural development. Such a role could help explain why a peptide that manifests deleterious gain-of-function activity when it oligomerizes in the aging brain has been evolutionarily conserved.

A Splicing Mutation in Slc4a5 Results in Retinal Detachment and Retinal Pigment Epithelium Dysfunction

Fluid and solute transporters of the retinal pigment epithelium (RPE) are core components of the outer blood-retinal barrier. Characterizing these transporters and their role in retinal homeostasis may provide insights into ocular function and disease. Here, we describe RPE defects in tvrm77 mice, which exhibit hypopigmented patches in the central retina. Mapping and nucleotide sequencing of tvrm77 mice revealed a disrupted 5' splice donor sequence in Slc4a5, a sodium bicarbonate cotransporter gene. Slc4a5 expression was reduced 19.7-fold in tvrm77 RPE relative to controls, and alternative splice variants were detected. SLC4A5 was localized to the Golgi apparatus of cultured human RPE cells and in apical and basal membranes. Fundus imaging, optical coherence tomography, microscopy, and electroretinography (ERG) of tvrm77 mice revealed retinal detachment, hypopigmented patches corresponding to neovascular lesions, and retinal folds. Detachment worsened and outer nuclear layer thickness decreased with age. ERG a- and b-wave response amplitudes were initially normal but declined in older mice. The direct current ERG fast oscillation and light peak were reduced in amplitude at all ages, whereas other RPE-associated responses were unaffected. These results link a new Slc4a5 mutation to subretinal fluid accumulation and altered light-evoked RPE electrophysiological responses, suggesting that SLC4A5 functions at the outer blood-retinal barrier.

Macular edema after surgical treatment of rhegmatogenous retinal detachment – the possibilities of its prediction

The aim: to develop a mathematical model for predicting macular edema based on the informativeness of clinical and instrumental predictors of its occurrence.Materials and methods. To determine the risk factors for macular edema 64 patients (64 eyes) with macula-off rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy (grade Cp 1–2) were selected. A retrospective analysis of the surgical treatment results was carried out. The age of the patients ranged from 30 to 81 years (28 women and 36 men).Results. Using regression analysis, two signifi cant factors were identifi ed: the sum of 8 meridians of the visual fi eld before surgery (p = 0.015) and the number of detached quadrants (p = 0.021). Based on the identifi ed factors, a model was obtained for predicting the occurrence of macular edema in the postoperative period for the patients with rhegmatogenous retinal detachment. Conclusion. Based on the analysis of clinical and instrumental indicators in patients with rhegmatogenous retinal detachment, a mathematical model has been developed that allows predicting the occurrence of macular edema in the postoperative period.The application of the proposed prediction model makes it possible to determine the tactics of treatment (peeling of internal limiting membrane) and predict the appearance of macular edema at the preoperative stage.

Laser treatment of macular retinal folds in late postoperative period after retinal detachment repair

Macular retinal folds are a rare yet grave complication of surgical rhegmatogenous retinal detachment repair. Clinical symptoms vary depending on the location and severity of folding. Fold located in the periphery of the ocular fundus can be asymptomatic, but macular retinal folds cause diminished visual acuity and metamorphopsia. Currently, the most effective treatment for retinal folds is repeat surgery. Its serious disadvantage is the risk of complications in the early postoperative period, including hemophthalmia, inflammation, secondary glaucoma, cataracts, RRD recurrence, macular tears, retinal vascular occlusion, etc. The clinical case described below demonstrates the potential of combination laser therapy for the treatment of macular retinal folds based on the use of modern diagnostic and therapeutic methods.

Macular edema risk factors after vitrectomy for rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy

BACKGROUND: Despite significant advances in the technology of surgical treatment of regmatogenous retinal detachment, a certain proportion of patients with emerging macular edema against the background of silicone oil tamponade remains. AIM: To evaluate the risk factors of macular edema development and to work out a mathematical model for its prediction based on a retrospective analysis of clinical data of patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy. MATERIALS AND METHODS: A retrospective case series of 64 patients (64 eyes) with regmatogenous retinal detachment complicated by grade CP proliferative vitreoretinopathy who underwent primary retinal detachment repair. Patients were divided into two groups: with the presence of macular edema in the postoperative period and without it (32 patients in each group). In all cases, at the initial examination, retinal detachment involved the macular area. RESULTS: Using regression analysis, two significant factors were identified: the sum of the 8 meridians of the visual field before surgery (p=0.015) and the number of detached quadrants (p=0.021). Based on the identified factors, a model for predicting macular edema occurrence in the postoperative period in the surgical treatment of regmatogenous retinal detachment was obtained. CONCLUSIONS: The investigation results allowed establishing that the retinal detachment area and the sum of the 8 meridians of the visual field are significant pre-operative factors for macular edema development in retinal detachments with proliferative vitreoretinopathy of CP 1-2 degree. The developed mathematical model based on these indicators is characterized by significant information content and allows predicting macular edema occurrence in the postoperative period. The use of the proposed prognostic model determines a differentiated approach to surgical prevention of macular edema and allows making a decision on the removal of internal limiting membrane at the preoperative stage.

Outer Retinal Folds Following Pars Plana Vitrectomy vs Pneumatic Retinopexy for Retinal Detachment Repair: Post Hoc Analysis from PIVOT

PURPOSE

To assess the incidence of post-operative outer retinal folds (ORFs) in pars plana vitrectomy (PPV) vs pneumatic retinopexy (PnR) following rhegmatogenous retinal detachment (RRD) repair and to determine the association of ORFs with functional outcomes at 1 year.

DESIGN

Randomized controlled trial PARTICIPANTS: Patients with primary macula-off RRD meeting PIVOT trial criteria randomly assigned to PPV vs PnR.

METHODS

Post-hoc analysis of the PIVOT trial. Incidence and quantitative morphological features of ORFs were assessed with en face and cross-sectional OCT at 1 month post-operatively by two masked graders. ETDRS letter score and quantitative metamorphopsia were measured at 1 year.

MAIN OUTCOME MEASURES

Proportion of patients with ORFs following PPV vs PnR at 1 month post-operatively. Secondary outcomes include the association of ORFs with visual acuity (ETDRS letter score) and metamorphopsia (M-CHARTS) at 12 months post-operatively.

RESULTS

Eighty-eight of the 176 participants enrolled in PIVOT were macula-off RRD. 94.3% (83/88) of these macula-off eyes had month 1 post-operative OCT scans that were gradable, 93.2% (41/44) in the PPV group and 95.5% (42/44) in the PnR group. The incidence of ORFs formation was 34.1% (14/41) in the PPV group and 14.3% (6/42) in the PnR group (p=0.034). ETDRS letter score at 1 year was 65.7±6.6 letters in patients with ORFs versus 75.1±1.4 letters in those without ORFs (difference=9.4 letters, 95% CI=7.5-11.3, p=0.047). Among patients in the PPV group only, mean ETDRS letter score at 1 year in patients with ORFs was 62.8 ± 24.7 letters compared to 75.4 ± 9.2 letters in patients without ORF formation (difference=12.6 letters, 95% CI=0.05-24.59, p=0.04). Horizontal and vertical metamorphopsia scores were similar in patients with vs without ORFs: horizontal: 0.35 ± 0.12 versus 0.29 ± 0.07 (difference=0.06, 95% CI=0.01-0.11, p=0.69) and vertical: 0.25±0.07 versus 0.29±0.07 (difference=0.04, 95%CI=0-0.08, p=0.60) respectively. There was a negative correlation between the closest distance of the ORFs from the fovea and the vertical metamorphopsia score (r=-0.507, p=0.045).

CONCLUSIONS

There is a greater risk of developing ORFs following PPV compared to PnR for RRD. ORFs at 1 month are associated with significantly worse ETDRS visual acuity letter score at 1 year.

Characteristics of spontaneous reattachment of rhegmatogenous retinal detachment: optical coherence tomography features and follow-up outcomes

PURPOSE

To investigate the clinical features of spontaneous reattachment of rhegmatogenous retinal detachment (SRRRD) with diffuse retinal pigmentary changes.

METHODS

This retrospective study included patients diagnosed with SRRRD. The diagnosis of SRRRD was made based on characteristic fundus findings, such as diffuse retinal pigmentary clumpings, retinal pigmentary atrophy, and convex lesion margins. The clinical features of SRRRD were also evaluated. In addition, optical coherence tomography (OCT) images and follow-up data were analyzed.

RESULTS

Twenty patients were included in the study. All the patients showed unilateral involvement. SRRRD predominantly involved the inferior or temporal retina (90.0%). On OCT, severe disruption of the outer retinal layers was noted in the region of SRRRD. A subretinal gliosis band was noted in 11 patients (55.0%), and an epiretinal membrane (ERM) was noted in nine patients (45.0%). In 18 patients, a mean follow-up of 24.9 ± 29.2 months was performed. During the follow-up period, no definite retinal changes were noted on fundus examination or OCT.

CONCLUSIONS

SRRRD usually involves the inferior or temporal retina. Although severe disruption of the retinal microstructure is noted in the involved region, the condition is likely to be stable. However, long-term follow-up is required to identify progression of the ERM.

Clinical Significance of Macula-Off Rhegmatogenous Retinal Detachment Preoperative Features on Optical Coherence Tomography

BACKGROUND AND OBJECTIVE

To evaluate the clinical significance of preoperative spectral-domain optical coherence tomography (OCT) features and their association with postoperative outcomes in eyes with primary macula-off rhegmatogenous retinal detachment (RRD).

PATIENTS AND METHODS

This is a retrospective case series of all consecutive cases undergoing repair of primary macula-off RRD at two tertiary care academic centers between January 2018 to January 2021.

RESULTS

Among 406 eyes, baseline visual acuity (β = 0.184, P = .001) and time to surgery (β = 0.009, P = .033) were predictive of postoperative visual acuity at 1-year follow-up after adjusting for age, sex and lens status, as well as presence of preoperative features on OCT such as outer retinal corrugations and height of the retinal detachment.

CONCLUSION

Baseline visual acuity and time to surgical repair are the best predictors of vision outcomes following macula-off RRD repair. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S23-S29.].

Microperimetry-Assessed Functional Alterations and OCT-Changes in Patients after Retinal Detachment Surgery Using Pars Plana Vitrectomy and SF6 Tamponade

Background: We study the retinal function measured by macular integrity assessment microperimetry (MAIA) and structural changes assessed by scanning swept source optical coherence tomography (SS-OCT) between healthy individuals and patients undergoing pars plana vitrectomy (PPV) after rhegmatogenous retinal detachment (RRD). Methods: Cross-sectional study. Early Treatment Diabetic Retinopathy Study (ETDRS) grids were measured by SS-OCT and compared with the MAIA parameters. Results: Thirty-eight eyes with RRD (19 macula-on and 19 macula-off) were compared with 113 healthy eyes. The retinal sensitivity and average total threshold were reduced in all sectors in the RRD group; macular integrity index was increased. Macular thicknesses in total retina and ganglion cell layer (GCL)++ protocols were higher in the RRD group in nasal outer (NO) and central (C) sectors and only in C sector for GCL+ protocol. Thicknesses were lower in total retina, GCL++ protocols in the temporal outer (TO) sector and in the GCL+ protocol in NO sector. Best-corrected visual acuity (BCVA) correlated moderately with retinal sensitivity in all sectors and in just several sectors with time between the date of surgery and the test. The central nasal (CN) sector thickness and the average total threshold were higher in the macula-on subgroup. Conclusions: RRD and subsequent surgery results in functional and structural changes, especially in individuals with macular detachment.

Management of fovea-involving dry macular fold complicating retinal detachment surgery: Does delayed intervention influence outcome?

Retinal folds are rare complications of rhegmatogenous retinal detachment surgery. They may be located in periphery or involve macula, with the latter ones being associated with severe visual loss. Due to the paucity of scientific reports, its management remains debatable. Most authors advocate an early surgical intervention for symptomatic macular folds (MF). We present 2 cases of symptomatic dry macular fold which were managed successfully after different time intervals. As evidence gets collected that late intervention also leads to good visual outcome, long standing MF should not be considered an absolute contraindication for surgical intervention.

Change in retinal and choroidal microvascular structures after rhegmatogenous retinal detachment surgery and effects on visual recovery

PURPOSE

To investigate changes in retinal and choroidal microvascular structures in the macular region after surgery for rhegmatogenous retinal detachment (RRD) and their relationship to visual function at 3months.

METHODS

This prospective, cross-sectional study included 37 eyes of 37 patients who underwent surgery for RRD (pneumatic retinopexy and/or pars plana vitrectomy). All patients underwent a comprehensive ophthalmologic examination, including measurement of best-corrected visual acuity (BCVA, logMAR), anterior segment and fundus examination, and optical coherence tomography angiography (OCTA) imaging 3months postoperatively. The healthy fellow eyes formed the control group. OCTA was used for the assessment of macular vessel density (VD), foveal avascular zone (FAZ), central macular thickness, and choroidal and outer retinal flow rates.

RESULTS

The findings showed that the VD of the superficial and deep capillary plexuses were lower in the RRD group compared to the control group (P=0.012; P<0.001). The FAZ was larger in the RRD group (P=0.035). The choroidal flows in the 1 and 3mm² were lower in the RRD group (P<0.001). Superficial FAZ area and choroidal flow rate (1 and 3mm² areas) were moderately negatively correlated with BCVA (P=0.008; P=0.035; P=0.008).

CONCLUSIONS

Our study demonstrated that the FAZ was larger, and the choroidal flow rate was lower, in the RRD group compared to the control group. Choroidal flow rate was negatively correlated with postoperative BCVA. Ischemic events resulting from the RRD were likely the reason for these changes.

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

AIM

To evaluate the advantages and safety of vitrectomy under air for treating macula-involving rhegmatogenous retinal detachment (RRD).

METHODS

Consecutive patients with macula-involving RRD who underwent vitrectomy under air were recruited. Demographic and clinical data were: age, gender, eye, lens status, best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR), axial length, intraocular pressure (IOP). RRD parameters were: RRD extent, retinal breaks number. Surgical data were: cataract surgery, tamponade used. Postoperative parameters were: BCVA, IOP at first, third, sixth month, recurrent RD, incidence of retinal folds, subretinal fluid (SRF) persistence, macular displacement.

RESULTS

Seventy-one eyes (71 patients) were recruited. Cataract surgery was performed in 32 of 45 phakic patients. The tamponade used was: sulfur hexafluoride 18% (41), silicon oil (SO) (26), high-density SO (4). BCVA improved significantly from baseline (1.2 ± 0.4 logMAR) to the last control (0.8 ± 0.7 logMAR) (P = 0.03285). Recurrent RD incidence was 14.1%. Postoperative complications were: retinal folds (2), SRF persistence (3), macular displacement (2).

CONCLUSION

Vitrectomy under air is a safe alternative technique for treating macula-involving RRD. Vitrectomy under air allows surgeon to remove accurately the vitreous from the peripheral retina and facilitates the removal of SRF reducing the complications related to its postoperative persistence.

Macular optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment

The primary aim of this study was to summarize and illustrate the main structural cross-sectional optical coherence tomography findings encountered after vitreoretinal surgery for rhegmatogenous retinal detachment. This was a non-systematic review of literature on structural cross-sectional optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment. Adequate illustrations of the main findings described were found after a retrospective analysis of imaging and charts of patients operated at the department where this study was performed. The main structural cross-sectional optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment included persistent subretinal fluid, subretinal blebs, retinal folds, subretinal perfluorocarbon liquids, macular alterations related to silicone oil, epiretinal membranes, proliferative vitreoretinopathy, cystoid macular edema, macular holes, and recurrent retinal detachment. In conclusion, optical coherence tomography was a useful tool after vitreoretinal surgery for rhegmatogenous retinal detachment. Some optical coherence tomography findings may not be evident on fundus examination, and optical coherence tomography can reveal essential details for the clinical management and the visual prognosis. Other findings, despite being visible on funduscopic examination, may be better assessed with the aid of optical coherence tomography. All these elements contribute to support the importance of tomographic assessment in the follow-up of eyes treated for vitreoretinal conditions.