Influence of Vitreous Cortex Remnants on Normal Retinal Anatomy in Eyes with Primary Rhegmatogenous Retinal Detachment

Abstract

To investigate the influence of vitreous cortex remnants (VCRs) removal on normal retinal anatomy in eyes with rhegmatogenous retinal detachment (RRD). Prospective cohort study. Patients with primary RRD operated with pars plana vitrectomy (PPV). Blue fundus autofluorescence and spectral-domain optical coherence tomography were obtained pre-operatively, and at 1 and 6 months after operation. Primary outcomes: rate of retinal displacement and outer retinal folds at 1 month after operation. continuity of the external limiting membrane (ELM) and ellipsoid zone (EZ), and the logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA) at 6 months after operation. One hundred three eyes were included. Intra-operatively, peripheral (p)VCRs were found in 42 eyes (40.8%) and successfully peeled off from ≥ 2 quadrants in 37 eyes. Macular (m)VCRs were detected in 37 (35.9%) and successfully peeled off in 29 eyes. At the end of operation 44.7% and 55.3% of the eyes were tamponaded with 20% sulfur hexafluoride gas and silicone oil 1000 centistokes, respectively. The only variable significantly associated with displacement was the use of gas tamponade vs. silicone oil (p=0.001) whereas no significant association was found between retinal displacement and pVCRs (p=0.58) or number of quadrants from which pVCRs were peeled off (p=0.39). At 1 month post-operatively ORFs were globally detected in 24 eyes (23.3%). Regression analysis showed a direct correlation between ORFs and the intraoperative detection of mVCRs (p=0.02) and an indirect correlation between ORFs and mVCRs peeling (p= 0.004). Macular VCRs peeling did not influence the continuity of ELM and EZ at the 6- month follow-up (FU). Intraoperative absence of mVCRs (p=0.0016) and peeling of mVCRs (p=0.003) were associated with logMAR BCVA ≤ 0.3 at the 6-month FU. Peeling of pVCRs did not seem to influence the rate of retinal displacement while peeling of mVCRs was associated with a reduced risk of developing ORFs without detrimental effect on the continuity of ELM/EZ at 6 month FU. The patients without mVCRs detected intraoperatively or who underwent mVCRs peeling during operation, showed a significantly better VA at the 6-month FU.