Microvascular retinal alterations in rhegmatogenous retinal detachment after pneumatic retinopexy

Pneumatic Retinopexy Involving the Use of Intravitreal Air Injection and Laser Photocoagulation for Rhegmatogenous Retinal Detachment in Phakic Eyes

The clinical efficacy of pneumatic retinopexy (PR) using intravitreal pure air injection and laser photocoagulation for rhegmatogenous retinal detachment (RRD) remains unknown. Thirty-nine consecutive patients with RRD (39 eyes) were included in this prospective case series. All patients underwent two-step PR surgery containing pure air intravitreal injection and laser photocoagulation retinopexy during hospitalization. The main outcomes were best-corrected visual acuity (BCVA) and primary anatomic success rates after PR treatment. The mean follow-up was 18.3 ± 9.7 months, ranging from 6 to 37 months. The primary anatomic success rate was 89.7% (35/39) after PR treatment. Final reattachment of the retina was achieved in 100% of cases. Macular epiretinal membrane was developed in two patients (5.7%) among successful PR cases during the follow-up. The mean logMAR BCVA value was significantly improved from 0.94 ± 0.69 before surgery to 0.39 ± 0.41 after surgery. The average central retinal thickness was significantly thinner in the RRD eyes of macula-off patients (206.8 ± 56.13 μm) when compared with the fellow eyes (234.6 ± 48.4 μm) at the last follow-up (p = 0.005). This study concluded that an inpatient PR procedure with pure air injection and laser photocoagulation is a safe and effective approach to treating patients with RRD, who may achieve a high single-operation success rate and good visual acuity recovery.

How should we report the foveal status in eyes with "macula-off" retinal detachment?

Whilst pre- and postoperative multimodal imaging technologies including optical coherence tomography (OCT) have investigated the morphological correlates of worsened visual outcomes in rhegmatogenous retinal detachment (RRD) with foveal involvement, the nomenclature has adhered to the traditional ophthalmoscopy-based and rather vague term "macula-off". This article appraises the current literature with regard to the preoperative assessment and nomenclature of the foveal status in macula involving retinal detachment (MIRD). A literature review of recent publications assessing functional or morphological outcomes in MIRD was conducted, using the search terms "fovea-off" or "macula-off". The search date was April 28^th, 2021. Original studies in English language were included. Case reports, review articles or letters were excluded. Forty relevant articles (range of publication dates: July 29^th, 2020 - April 18^th, 2021) were reviewed to assess the diagnostic modalities used, morphological parameters assessed, and any specific nomenclature introduced to specify the extent of macular detachment. The results suggest widespread variability and inconsistencies with regard to the preoperative assessment, diagnostic modalities and nomenclature used to describe the foveal status in eyes with RRD termed "macula-off". The extent of macular detachment may be classified by a wide range of morphological parameters, including the height of foveal detachment and the ETDRS grid as overlay tool in OCT devices. There is a scientific and clinical need for an updated nomenclature for eyes with "macula-off" RRD. Preoperative OCT findings should be reported on a regular and standardized basis in order to establish a consensus how to report the foveal status in eyes with MIRD.

Macular microcirculation changes after repair of rhegmatogenous retinal detachment assessed with optical coherence tomography angiography: A systematic review and meta-analysis

Purpose: The aim of the study was to investigate microcirculation changes in the macula evaluated by optical coherence tomography angiography (OCTA)in patients receiving anatomical repair after surgery for rhegmatogenous retinal detachment (RRD). Methods: A literature search was conducted in PubMed, EMBASE, Web of Science and the Cochrane Library. Studies including patients with macula-on or macula-off RRD and repaired successfully through primary surgery were selected. Foveal avascular zone (FAZ) area and macular vascular density (VD) in both the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were analyzed using RevMan 5.4 software. Results: Twelve studies including 430 RRD eyes and 430 control eyes were selected. In eyes with macula-on RRD, FAZ area, VD in the foveal SCP and DCP, and VD in the parafoveal SCP and DCP were not altered compared with control eyes, after the retina was reattached. In eyes with macula-off RRD that was repaired successfully through surgery, FAZ area in the DCP (0.13 mm², 95% CI: 0.02 to 0.25, p = 0.02) remained enlarged compared with control eyes. Meanwhile, VD in the foveal DCP was also significantly reduced (-3.12%, 95% CI: -6.15 to -0.09%, p = 0.04), even though retinal reattachment was achieved by surgery in eyes with macula-off RRD. Conclusion: In patients with macula-off rhegmatogenous retinal detachment, foveal avascular zone area in the deep capillary plexuses was enlarged and vascular density in the foveal deep capillary plexus was reduced, even after the retina was successfully reattached through a primary surgery.

Differences in Vascular Density between Detached and Nondetached Areas in Eyes with Rhegmatogenous Retinal Detachment

We examined the vessel density (VD) of the deep capillary plexus (DCP) and choriocapillaris plexus (CCP) by optical coherence tomography (OCT) angiography in eyes with rhegmatogenous retinal detachment, which had similar amounts of detached and nondetached areas in the macula region, and then determined the morphology by OCT until 6 months after surgery. A total of 13 eyes of 13 patients whose average age was 55.8 ± 12.3 years and were successfully treated were enrolled in this study. Throughout the postoperative period, the VD of the DCP in the detached area decreased significantly compared to that in the nondetached area. Conversely, there was no significant difference in the VD of the CCP between the detached and the nondetached areas. The ratio of VD of both the DCP and CCP in the detached area to the in the nondetached area did not show significant changes during the follow-up period of 6 months. The ratio of VD of the DCP in the detached area to that in the nondetached area correlated significantly with the ratio of the external limiting membrane−ellipsoid zone (r = 0.57, p < 0.001) and ellipsoid zone−retinal pigment epithelium (r = 0.39, p < 0.001) thickness in the detached area to that in the nondetached area. A well-preserved DCP blood flow could result in the restoration of the outer retina.

Association of microvasculature changes with visual outcomes after successful retinal detachment surgery

PURPOSE

To evaluate macular microvascular changes and their correlation with visual outcomes after rhegmatogenous retinal detachment (RRD) surgery.

DESIGN

Retrospective case series PARTICIPANTS: Seventy-four eyes successfully operated for RRD were included in the study.

METHODS

The area of the foveal avascular zone in the superficial capillary plexus, the vessel density in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillary plexus (CCP) were evaluated using optical coherence tomography angiography (OCTA) at 1 and 6 months postoperatively. The fellow eyes were used as controls for comparison.

MAIN OUTCOME MEASURES

The correlation between OCTA parameters and postoperative best-corrected visual acuity (BCVA) was assessed using a hybrid linear mixed model. We also analyzed the relationship between OCTA parameters and the integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) of photoreceptors.

RESULTS

The median vessel density in the DCP was significantly decreased in RRD eyes at 1 month (p=0.019), but gradually improved over time to reach the value of the fellow eyes at 6 months (p=1). There was no significant difference between the 2 groups in median foveal avascular zone area, vessel density in the SCP and in the CCP (p=0.579, p=0.618, p=0.068 and p=0.819, p=1 and p=1, respectively) at both 1 and 6 months postoperatively. Postoperative BCVA was positively correlated with the vessel density in the DCP (p=0.009) in multivariate analysis. Eyes with low 1-month vessel density in the DCP tended to have worse final BCVA (p=0.067). There was no correlation between the vessel density in the DCP and ELM and/or EZ integrity at both 1 (p=0.156) and 6 months postoperatively (p=0.161). Eyes with intact ELM and EZ at 6 months, however, had significantly higher 1-month vessel density in the DCP than those with disrupted ELM and/or EZ (p=0.027).

CONCLUSION

The vessel density in the DCP was affected in RRD eyes as well as associated with postoperative BCVA and the restoration of photoreceptor layers. It might thus serve as a predictor for visual recovery following successful RRD surgery.