Effect on macular structure and visual acuity after scleral buckling and pars plana vitrectomy for macula-off rhegmatogenous retinal detachment

Abstract

Background The patients who have undergone successful surgery for retinal detachment (RD) cannot recover their vision quickly, and the reason is not very clearly now. Objective This study was to compare the ellipsoid zone integrity in macula and frequency and duration of subretinal fluid after scleral buckling and pars plana vitrectomy (PPV) in primary macula-off rhegmatogenous RD, and to discuss the sequent influence of subretinal fluid on postoperative visual acuity. Methods A retrospective analysis was carried out on 66 cases of rhegmatogenous RD in Peking University People's Hospital from January 2010 to January 2013.All the cases were divided into 2 groups: scleral buckling group and PPV group.The courses of disease, refractive status, best corrected visual acuity (BCVA) and complications were recorded.The duration of subretinal fluid and ellipsoid zone integrity in macula were observed and the occurrence rates of subretinal fluid were calculated 1 month after surgery. Results There were no statistic differences on age, gender, courses of disease, refractive status and LogMAR visual acuity (all at P>0.05). The average duration of subretinal fluid was (96±60) days in scleral buckling group, and (21±6) days in PPV group, with a statistically significant difference between the two groups (t=7.966, P=0.000). The occurrence rate of subretinal fluid at 1 month after surgery was 78.6% in the scleral buckling group and 12.5% in the PPV group, with a statistically significant difference between the two groups (χ2=26.891, P=0.000). The LogMAR visual acuity was significantly different between the patients with and without subretinal fluid at 1 month after scleral buckling surgery (t=3.185, P=0.003). The LogMAR visual acuity was not significantly different between the scleral buckling group and PPV group 6 months after scleral surgery (t=1.876, P=0.065). The LogMAR visual acuity was not significantly different between the patients with and without subretinal fluid at 6 month after scleral buckling surgery (t=1.755, P=0.087). After the subretinal fluid was reabsorbed, the LogMARs visual acuity were significantly different between the patients with intact ellipsoid zone and with disrupt ellipsoid zone in both groups (scleral buckling group: t=2.555, P=0.015; PPV group: t=4.005, P=0.001). Conclusions The disruption extent of the ellipsoid zone is related to the duration of RD, and the integrity affects the postoperative visual acuity distinctly.The subretinal fluid is removed more rapidly after PPV when compared with scleral buckling in macula-off rhegmatogenous RD.The subretinal fluid delays visual recovery postoperatively but the operation method does not influence final visual acuity seriously. Key words: Rhegmatogenous retinal detachment; Scleral buckling; Pars plana vitrectomy; Subretinal fluid; Ellipsoid zone