Macula-on Rhegmatogenous Retinal Detachment Research Articles

CHARACTERISTICS, OUTCOMES, AND OPTICAL COHERENCE TOMOGRAPHY FEATURES OF MACULAR HOLE AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To investigate full-thickness macular holes (FTMHs) that develop after rhegmatogenous retinal detachment (RRD) repair. Retrospective consecutive case series of patients who underwent RRD repair between 2015 and 2021 and subsequently developed FTMH. Twenty-three patients (23 eyes) were included. All eyes underwent pars plana vitrectomy + membrane peel for macular hole (MH) repair. The mean age at RRD diagnosis was 62 years and 52% were male. In total, 78% were macula-off RRDs. Fourteen eyes (60.9%) underwent pars plana vitrectomy alone, 7 (30.4%) underwent pars plana vitrectomy and scleral buckling, 1 (4.3%) underwent scleral buckling only, and 1 (4.3%) underwent pneumatic retinopexy. Median time from RRD repair to MH diagnosis was 116 days. Macula-off RRDs had a significantly lower time to MH diagnosis (mean 154 days, P < 0.05) than macula-on RRDs (mean 875 days). Twenty-one MH (91%) had optical coherence tomography evidence of an epiretinal membrane. Mean logMAR visual acuity at MH diagnosis was 1.05 (∼20/224) and significantly improved to 0.66 (∼20/91) at the final follow-up ( P < 0.001); 100% of MHs closed by the final follow-up. Pars plana vitrectomy for MH after RRD repair has a high closure rate and leads to significant VA improvement. MH formation after RRD repair may be associated with macula-off detachments and epiretinal membrane. Macula-off RRDs develop MH faster than macula-on RRDs.

Quantitative Microvascular Change Analysis Using a Semi-Automated Algorithm in Macula-on Rhegmatogenous Retinal Detachment Assessed by Swept-Source Optical Coherence Tomography Angiography.

The purpose of this study was to objectively evaluate the longitudinal changes observed in the retinal capillaries in eyes with macula-on rhegmatogenous retinal detachment (RRD), assessed with optical coherence tomography angiography (OCTA), and to assess the role of these microvascular measures as potential biomarkers of postoperative visual outcomes. This was a prospective, longitudinal study conducted on consecutive patients who underwent 25 G pars plana vitrectomy for primary RRD. The vessel area density (VAD), vessel skeleton density (VSD), and vessel diameter index (VDI) were assessed in the superficial (SCP) and deep (DCP) capillary plexuses. Twenty-three eyes with macula-on RRD were included in the study. The mean preoperative VDI, VAD, and VSD of the RRD eye were 18.6 ± 1.1, 0.43 ± 0.02, and 0.17 ± 0.01 in the SCP; and 18.6 ± 0.6, 0.38 ± 0.03, and 0.15 ± 0.01 in the DCP, respectively. At month 6, eight (34.8%) eyes achieved a best-corrected visual acuity (BCVA) gain ≥ 0.1 LogMAR. A preoperative VDI > 17.80, VSD > 0.170, and VDI-change > -0.395 in the SCP; and VDI > 18.11 and VDI change > -0.039 in the DCP were predictors of achieving a BCVA-gain ≥ 0.1 LogMAR. The preoperative VDI in SCP and DCP, the preoperative VSD in SCP, and their changes from preoperative values were predictors of visual outcomes. A quantitative OCTA analysis of capillary density and morphology may represent a potential predictive tool for surgical outcomes in RRD. The results reported in this study suggest that OCTA is a useful ancillary test for clinical disease management.

Effect of silicone oil versus gas tamponade on macular layer microstructure after pars plana vitrectomy for macula on rhegmatogenous retinal detachment

PurposeTo analyze structural changes in the macular retinal layers and sub-foveal choroidal thickness (SFCT) in eyes after macula-on rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy with either silicone oil (SO) or gas tamponade, and the effect of these changes on visual acuity.Patients and methodsRetrospective study which included 26 eyes in the SO Group and 32 in the Gas Group. Optical coherence tomography (OCT) scans of the affected eyes were obtained before surgery, and 3 months after PPV in the Gas Group, and during silicone oil in situ and 3 months after SO removal, in the SO Group. Qualitative assessment of photoreceptor layer and foveal contour, along with quantitative assessment of macular retinal thickness and SFCT was performed. Postoperative OCT macular microstructural changes were recorded and correlated to corrected distance visual acuity (CDVA). Intraocular pressure (IOP) was measured preoperative and at 3 months post operative.ResultsThere was a 2-line loss (from 20/28 preoperatively to 20/40 at final follow-up) of CDVA in the SO Group (p=0.051), while there was no statistically significant change in CDVA in the Gas Group (p=0.786). There was no significant correlation between CDVA loss and duration of silicon tamponade (r=-0.031, p=0.893). There was a statistically significant increase in IOP from its baseline to final follow-up of 0.7 mmHg in the SO Group (p=0.023) while there was no statistically significant change in IOP in the Gas Group. During silicone oil tamponade, there was approximately 11% and 5% of retinal and sub-foveal choroidal thinning respectively, which was moderately resolved following silicone oil removal. 20% (5/24) of eyes in the SO Group had qualitative flattening of foveal contour during SO tamponade that resolved after SO removal.ConclusionThinning of the macula was noticed after macula-on RRD repair with SO tamponade. Such thinning was only partially reversible after the removal of SO.

Assessment of Microvascular Changes After Rhegmatogenous Retinal Detachment Repair Using Wide-Field Swept-Source Optical Coherence Tomography Angiography.

Our objective was to evaluate retinal microvascular changes and visual outcomes following rhegmatogenous retinal detachment (RRD) repair using wide-field swept-source optical coherence tomography angiography (WF SS-OCTA). The study included 116 eyes of 111 patients with macula-off (n = 68) or macula-on (n = 48) RRD treated with a single successful procedure, 79 fellow eyes, and 183 eyes of control patients imaged with WF SS-OCTA (3 ×3, 6 ×6, and 12 ×12 mm images). Mixed-effects multiple linear regression models were used for statistical analysis. Vessel density (VD) and vessel skeletonized density (VSD) of the superficial capillary plexus (3 ×3 mm scans) and full-thickness retina (12 ×12 mm) were significantly reduced in RRD eyes compared to fellow and control eyes. Decreased VSD and VD in all layers (3 ×3 mm and 6 ×6 mm) were significantly associated with greater preoperative extent of retinal detachment (P < 0.05) and poorer postoperative best-corrected visual acuity (BCVA) in RRD eyes (P < 0.05). Macula-off status was associated with increased foveal avascular zone irregularity (12 ×12 mm, P = 0.02). Decreased VD on WF SS-OCTA is associated with poorer postoperative BCVA following RRD repair. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

CLINICAL FEATURES AND SURGICAL OUTCOMES OF SCLERAL BUCKLE SURGERY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT: MOORFIELDS BUCKLE STUDY.

Long-term study to evaluate the clinical and surgical outcomes of SB surgery for primary rhegmatogenous retinal detachment (RRD) at a large tertiary eye center. Non-comparative, retrospective case series of 589 eyes of 569 patients with primary RRD who underwent SB surgery between 2004 and 2022 with median follow-up of 6 months. Main outcome measures were best-corrected visual acuity (BCVA), surgical outcomes, complications, and classification of RRD. At baseline, 447/589 (76.1%), round hole-RRD and 133/589 (22.7%) retinal dialysis-RRD. Overall primary SB success rate was 83.7% for all RD subtypes, with round hole-RD 84.8% and dialysis-RRD 81.2%. Overall, Baseline BCVA was logMAR 0.42 and final logMAR 0.26 (p<0.0001). In macula-OFF RRD, the BCVA significantly improved from 0.79 to 0.48 logMAR (p<0.0001). Macula-ON RRD patients improved from 0.19 to 0.12 logMAR (p=0.014). Binary logistic regression showed registrar surgeon grade (OR 0.09,95% CI 0.01- 0.55), and partial or complete PVD (OR 0.21,95% CI 0.10 - 0.49) associated with reduced odds of primary success. Higher surgical failure associated with low pre-fellowship SB surgeon experience (p=0.024). We report favourable visual and functional outcomes in a large series of SB for primary retinal detachment, mainly for round hole and retinal dialysis RRD patients.

Macular hole following scleral buckling for rhegmatogenous retinal detachment: a case series

BackgroundMacular hole (MH) development following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) repair is rare. This study presents both full-thickness MH (FTMH) and lamellar MH (LMH) cases following SB for the treatment of RRD.MethodsClinical records of patients undergoing SB surgery for treatment of RRD at the Xi’an People’s Hospital (Xi’an Fourth Hospital) from January 2016 to December 2021 were reviewed, and cases with postoperative MH were selected. Clinical features and follow-up data were summarised, and possible causes were analysed.ResultsAmong 483 identified cases (483 eyes), four eyes (three male patients, one female patient) had postoperative MH, with prevalence, mean age, and mean axial length of 0.83%, 43.5 ± 10.66 years, and 29.13 ± 3.80 mm, respectively. All patients did not undergo subretinal fluid (SRF) drainage. The mean time for detecting MH was 26 ± 15.5 days postoperatively. Macula-off RRD with high myopia and FTMH combined with retinal re-detachment were diagnosed in three patients. One patient had macula-on RRD with outer LMH. The average follow-up duration was 7.25 ± 1.5 months. The FTMH closed successfully after reoperation, while the outer LMH closed without intervention. Visual acuity insignificantly improved or slightly decreased in all patients.ConclusionsPatients with high myopia combined with macula-off RRD might be more susceptible to FTMH, causing MH related retinal detachment. Additionally, LMH following SB was noted in patients with macula-on RRD. Therefore, we should raise awareness of MH following SB for RRD repair.

Baseline imaging characteristics and early structural changes in macula on rhegmatogenous retinal detachment

Animal models have demonstrated that structural changes affect the macula during peripheral rhegmatogenous retinal detachment. This study aimed to assess photoreceptors, retinal and choriocapillaris perfusion in non-macula involving rhegmatogenous retinal detachment by analyzing en-face images from structural OCTA segmented at the ellipsoid zone (EZ) level, calculating (1) “normalized” reflectivity as a surrogate biomarker of photoreceptor damage (2) perfusion density (PD), vessel length density (VLD) and vessel diameter index (VDI) of superficial capillary plexus (SCP) and deep capillary plexus (DCP) (3) perfusion density of choriocapillaris (PDCC). Twenty-one eyes affected by macula-on rhegmatogenous retinal detachment (RRD) were enrolled at the University “G. d’Annunzio”, Chieti-Pescara. The fellow unaffected eye was used as control. The mean age at the onset of RRD was 60.09 ± 10.22 (range 34–83). Compared with fellow eyes, we found lower EZ “normalized” reflectivity in macula-on (0.42 ± 0.15 in fellow eyes and 0.31 ± 0.09 in macula on p = 0.004). The affected eye was also characterized by impaired perfusion in SCP (17.26 ± 3.34% in macula on and 20.56 ± 3.62% in the fellow eye p = 0.004) and CC (50.21 ± 6.20% in macula on the eye and 57.43 ± 6.20% in the fellow eye p = 0.004). Macula-on rhegmatogenous retinal detachment has subclinical changes in photoreceptors, SCP, and CC. Future longitudinal studies should evaluate if early changes could impact post-operative macular function.

Modification of the Suprachoroidal Buckling Technique for the Treatment of Rhegmatogenous Retinal Detachment.

To describe modification of the suprachoroidal buckling technique for the treatment of rhegmatogenous retinal detachment (RRD), which may improve the safety profile. A single-surgeon foot-pedal-controlled automated suprachoroidal injection (SCI) of sodium hyaluronate 1%, namely ProVisc (Alcon Laboratories, Fort Worth, TX) was used for the treatment of RRD. MicroDose Injection Kit (MedOne Surgical, Sarasota, FL) including a connector and a 1-mL syringe, designed for subretinal injection, was used to adapt Constellation Vision System (Alcon Laboratories) console for SCI of ProVisc from the 1-mL syringe. This approach enables better surgeon control during SCI. Three highly myopic eyes of three patients with primary macula-on RRD and single superior peripheral retinal break were treated. Complete retinal reattachment was achieved in all eyes without complications. Injecting ProVisc under foot-pedal control provides a more precise and potentially safer suprachoroidal buckling technique compared with the manual technique with more variable injection speed and pressure.

Outcomes of Scleral Buckling After Failed Pneumatic Retinopexy.

Purpose: To assess the visual and anatomic outcomes of eyes that had secondary scleral buckle (SB) surgery after unsuccessful pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RRD). Methods: A retrospective study, performed over a 12-year period, comprised patients who had secondary SB procedures after failed primary PR. Clinical parameters (eg, best-corrected visual acuity [BCVA], lens status, macula status, details of RRD and subretinal fluid) were assessed at presentation, before additional procedures, and at follow-up (6 months, 1 year, and last visit). Statistical comparisons were made using Brown-Forsythe and Welch analysis-of-variance tests, with significance levels set at P < .05. Results: Fifty-four eyes with adequate follow-up were included. Forty-four (81.5%) of 54 eyes had successful retinal reattachment with secondary SB alone. The remaining eyes had subsequent pars plana vitrectomy (PPV). Patients presenting with macula-on RRD who had successful secondary SB had no statistically significant change in BCVA from baseline (mean final, 0.23 ± 0.25 logMAR [Snellen 20/34]; P = .999). There was a statistically significant improvement in BCVA in patients presenting with macula-off RRD who had successful secondary SB (mean final, 0.32 ± 0.36 logMAR [20/42]; P < .001 and mean change, -1.06 ± 0.85 logMAR). Ten patients presenting with macula-off RRD who had failed secondary SB had a significant improvement in the final BCVA (mean final, 0.22 ± 0.28 logMAR [20/33]; P = .044), despite the need for an additional PPV to achieve reattachment. Conclusions: Secondary SB remains a good option for RRD repair after unsuccessful PR and may avoid the need for PPV.

The effect of patient symptom awareness on the visual outcome in retinal detachment.

To explore whether a patient's prior knowledge of the symptoms associated with rhegmatogenous retinal detachment (RRD) relates to the visual outcome after treatment. We performed a prospective survey study on 126 patients receiving treatment for primary RRD between March and July 2021. Thirty-seven per cent (n = 47) of patients responded that they were aware of the RRD symptoms prior to the detachment. A history of RRD in the fellow eye or knowledge of family members treated for RRD was frequently reported as a reason for the patient's awareness of RRD symptoms. Patients aware of RRD symptoms presented significantly more often with an attached macula (χ2 , p = 0.002) and a better visual outcome following surgery (Mann-Whitney U, p = 0.028) compared to patients who were not aware of RRD-related symptoms. Among 76 patients with a myopic refractive error, only 15% (n = 11) indicated that they had been warned about the increased RRD risk related to myopia, suggesting that three-quarters of patients were not actively informed by their eye care professionals. RRD symptom awareness is significantly related to a higher rate of macula-on RRDs and better visual outcomes after treatment. There is limited awareness of increased RRD risk in myopic RRD patients. These findings suggest that counselling individuals at high risk of RRD about related symptoms is inadequate and better counselling may improve visual outcomes following RRD treatment.

Rhegmatogenous retinal detachment in choroidal melanoma: clinical features and surgical outcomes.

To describe the clinical features, prognostic factors, safety and rate of success of surgery and visual outcomes in patients with rhegmatogenous retinal detachment (RRD) and choroidal melanoma (CM). A retrospective, observational case-series of 21 patients with rhegmatogenous retinal detachment or combined tractional-rhegmatogenous retinal detachment in patients with choroidal melanoma over a period of 20 years. Nineteen patients were included in the final analysis. The mean elevation of CM was 4.0 mm and the mean largest diameter was 11.0 mm. RRD occurred after the CM treatment in 14 eyes at a mean interval of 44.2 months. The RRD was macula-on RRD in 6 eyes, there was posterior vitreous detachment (PVD) in 15 and PVR in 7 eyes. BCVA at presentation was 0.71 logMAR and final was 1.5 logMAR (p = 0.01). The primary surgical success rate was 59%. No intraocular or extraocular tumour dissemination occurred. Mean follow-up was 66 months. RRD in patients with CM is uncommon but requires multidisciplinary management. Anatomical results are favourable but visual outcomes are poor due to a combination of factors related to melanoma treatment, macular retinal detachment and PVR. Vitrectomy as a surgical intervention for RRD in treated CM appears to be safe in terms tumour dissemination.

Correlation between optical coherence tomography angiography-based data and postoperative visual acuity in patients that underwent surgery for macula-on RRD and macula-off RRD

Background: Despite advances in surgical techniques for rhegmatogenous retinal detachment (RRD) repair, patients are still at high risk for low functional outcomes. Given the above, it is important to find reasons for disappointment at the outcomes of vitreoretinal surgery for RRD. Impaired retinal microcirculation is a possible cause of insufficiently good functional outcomes in surgery for RRD. Purpose: To compare postoperative optical coherence tomography angiography (OCTA)-based changes in retinal microcirculation in the eyes of patients that underwent surgery for macula-on RRD versus the eyes of patients that underwent surgery for macula-off RRD and (2) to establish a relationship between OCTA data and best-corrected visual acuity (BCVA). Material and Methods: This prospective study included 116 patients. Of these, 65 underwent surgery for macular-on RRD (group 1) and 51, surgery for macular-off RRD (group 2). OCTA-based retinal vasculature parameters (foveal avascular zone (FAZ) area, parafoveal superficial capillary plexus (SCP) density and deep capillary plexus (DCP) density, vessel diameter, and vessel tortuosity index (VTI)) and their correlation with BCVA were assessed. Follow-up duration was 12 months. Results: In group 1, there was a negative correlation between the FAZ area and the macular thickness (r = - 0.299, p = 0.025) at month 12. The final BCVA was associated with the parafoveal DCP density (r = - 0.340, p = 0.010) and FAZ area (r= 0.390, p = 0.003). At 12 months, in group 2, the BCVA negatively correlated with the FAZ area (r = - 0.408, p = 0.012) and parafoveal SCP density (r = - 0.451, p = 0.005). In addition, there was a negative correlation between the parafoveal DCP density and the postoperative BCVA (r = - 0.418). There was no correlation between the FAZ area and the macular thickness (r = - 0.282, p = 0.080). Conclusion: The poorer vessel tortuosity index and parafoveal vessel density and diameter, the lower was postoperative visual acuity.

The long-term outcome of eyes with unexplained visual loss after gas tamponade for macula-on retinal detachment.

To analyze the long-term outcome of eyes suffering from unexplained visual loss after gas tamponade for primary macula-sparing rhegmatogenous retinal detachment (RRD). Cross-sectional analysis of all eyes with macula-on RRD experiencing an unexplained loss of vision after gas reabsorption that were treated and followed from 2010 to 2019. The investigational work-up included: best-corrected visual acuity (BCVA), clinical examination, spectral-domain optical coherence tomography (SD-OCT) and automated computerized perimetry. The 9 eyes of the 9 patients were analyzed after 5.9±2.4 years. BCVA improved by 0.54±0.50 logMAR from baseline, achieving a final value of 1.17±0.52 logMAR (∼20/320; p=0.0115). The thicknesses of the macula, of the macular ganglion cells and of the retinal nerve fiber layers were unchanged compared to the baseline, as well as the rate of ellipsoid zone defects (22.2%). The proportion of eyes with microcystoid macular edema (MME) significantly decreased to 44.4% (p=0.0294). Perimetry mean deviation increased from a baseline value of -18.06±2.72 to -17.23±2.29 dB (p=0.0390), with an unchanged pattern standard deviation (p=0.1289). In general, a reduction of the scotomata relative depth from baseline was evident in all eyes. Eyes with macula-on RRD suffering from unexplained visual loss after gas reabsorption, despite disclosing an overall unchanged structural macular morphology, showed a moderate, but significant, visual and perimetric improvement in the long-term.

Vascular density and macular sensitivity in eyes after scleral buckling surgery for macula-on rhegmatogenous retinal detachment.

To investigate the structure and function of the retina after scleral buckling (SB) surgery due to macula-on rhegmatogenous retinal detachment (RRD). Twenty eyes with repaired macula-on RRD and 20 fellow eyes were included. All patients within 6-12 months of the procedure, were examined to evaluate retinal structure using spectral domain optical coherence tomography (SD-OCT) and vessel density (VD) by OCT angiography (OCTA). Best corrected visual acuity (BCVA) and microperimetry (MP) tests were used to assess retinal function. Analysis of the microvascular network using OCTA between the operated and healthy fellow eyes showed a significant reduction on VD in superficial vascular plexus (SVP), deep vascular plexus (DVP) and radial peripapillary capillaries (RPC) (p< 0.001, p = 0.019 and p = 0.008, respectively). Comparison of retinal structure in SD-OCT showed no significant differences on thickness in ganglion cell complex (GCC) and peripaillary retinal nerve fiber layer (pRNFL) (p> 0.05) between examined eyes. Retinal function analysis by MP examination showed a decrease of retinal sensitivity (p = 0.0013) whereas postoperative BCVA showed no differences (p = 0.62) in the operated eyes. Significant Pearson's correlations were observed between retinal sensitivity and VD in SVP, RPC (p< 0.05). In the eyes after SB surgery due to macula-on RRD, changes in retinal sensitivity were accompanied by impairment of the microvascular network assessed by the OCTA.

Unexplained visual loss after primary pars-plana-vitrectomy with silicone oil tamponade in fovea-sparing retinal detachment

BackgroundTo investigate the incidence and clinical characteristics of unexplained visual loss in patients with fovea-sparing rhegmatogenous retinal detachment (RRD) during or after silicone oil (SO) tamponade.MethodsThe medical charts of all patients with macula-on RRDs, who underwent pars-plana-vitrectomy (ppV) with SO tamponade were retrospectively assessed regarding unexplained visual loss (UVL) of ≥ 3 Snellen lines and alterations on optical coherence tomography (OCT) during or after SO tamponade. The clinical data analysed included visual acuity, surgical parameters, OCT images, duration of SO tamponade and the time point of visual decline. Cases with re-detachment or secondary causes of visual loss such as SO emulsification, epiretinal membranes or macular edema were excluded.ResultsOver a 15-year-period, 22 cases with macula-on RRD, which had primarily been treated with ppV and SO tamponade, met the inclusion criteria. In most eyes (n = 20; 91%), the RRD was caused by a giant retinal tear (GRT). In 11 of these 22 cases (50%), best-corrected visual acuity (BCVA) had dropped by at least 3 lines for no apparent reason. In these 11 cases, mean preoperative logMAR BCVA was 0.2 (SD 0.13; range 0-0.5), equal to Snellen’s VA of 0.63, and mean postoperative logMAR BCVA 1.0 (SD 0.24; range 0.5–1.3), equal to Snellen’s VA of 0.10. Visual decline occurred about 12 weeks postoperatively (SD 6.2; range 3–20 ) and comprised 8 lines (SD 2.3; range -11 to -4). SO was removed on average 139 (SD 50.0; range 88–271) days after the first ppV. In 9 cases visual decline occurred while the SO was in-situ. In 2 patients, BCVA decline was noted 2 weeks after SO removal. In all eyes, preoperative central foveal thickness (CFT) was 254 μm (SD 24.2), which decreased to 224 μm (SD 29.6) during SO tamponade and increased to 247 μm (SD 29.2) after SO removal, irrespective of the presence of UVL. The mean follow-up time was 20 months (SD 30.6) after SO removal.ConclusionUVL after SO tamponade for macula-on RRD is more frequent than expected. The incidence in our case series was 50%. The mechanism of this phenomenon is still unknown. In general, vitreoretinal surgeons should thoroughly question the need for SO tamponade, inform their patients of possible UVL and remove SO as early as possible.Trial registrationThe study was approved by the local ethics committee on 6th of May 2022 (Ethikkommission der Universität Regensburg, Votum 22-2925-104) and was conducted in accordance with the ethical standards of the Declaration of Helsinki.

Postoperative complications after successful primary rhegmatogenous retinal detachment repair

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

Сравнение анатомической и функциональной эффективности радиального эписклерального пломбирования и комбинированной лазер-хирургической технологии при локальной macula-on отслойке сетчатки

Aim: to compare anatomical and functional outcomes of scleral buckling (SB) and combined laser and surgical intervention for focal macula-on rhegmatogenous retinal detachment (RRD). Patients and Methods: surgical outcomes of 84 patients (84 eyes) with focal RRD were analyzed. The study group included 43 patients (43 eyes) who underwent combined laser and surgical treatment for RRD that involved Nd:YAG laser excision of vitreoretinal adhesions followed by pneumoretinopexy and barrier laser photocoagulation. The control group that included 41 patients (41 eyes) was a retrospective sample of patients who underwent radial SB as described. Anatomical (the number of patients with attached retinal after a single surgical intervention and recurrence rate after surgery) and functional efficacy of the surgery were compared over a 2-year follow-up. Results: complete retinal reattachment was reported in 40 patients (93%) in the study group and 39 patients (95.1%) in the control group. Recurrent RD occurred in 3 patients (7.5%) in the study group and 4 patients (9.7%) in the control group over a 2-year follow-up. After 2 years, the final anatomical efficacy was 86% in the study group and 85% in the control group. Notably, no recurrent RD at the site of surgery was reported in the study group. Meanwhile, recurrent RD in the area of the primary retinal tear was reported in 1 patient in the control group. When comparing functional outcomes between the groups, a significant decrease in BCVA accounted for by an increase in astigmatism and spherical equivalent was reported after SB. Conclusions: the combined laser and surgical treatment is not inferior to SB in terms of anatomical efficacy and significantly superior to SB in terms of functional efficacy due to no changes in refractive indices after surgery. KEYWORDS: rhegmatogenous retinal detachment, optical coherence tomography, YAG laser retinotomy, vitreoretinal traction, treatment, recurrence. FOR CITATION: Taevere M.R., Kryl L.A.', Doga A.V., Shkvorchenko D.O. Anatomical and functional efficacy of radial scleral buckling and combined laser and surgical intervention for local macula-on retinal detachment. Russian Journal of Clinical Ophthalmology. 2023;23(3):119– 123 (in Russ.). DOI: 10.32364/2311-7729-2023-23-3-2.

Microvascular Changes after Scleral Buckling for Rhegmatogenous Retinal Detachment: An Optical Coherence Tomography Angiography Study.

This retrospective study aimed to investigate macular microvascular alterations after successful scleral buckling (SB) for rhegmatogenous retinal detachment (RRD). Nineteen eyes with macula-on RRD and 18 eyes with macula-off RRD were included. In all cases, an encircling band was placed. Optical coherence tomography angiography (OCTA) was performed at baseline and postoperatively. Changes in the foveal avascular zone (FAZ) area and vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were the primary outcomes. Correlations between OCTA findings and clinical variables were considered secondary outcomes. In both the macula-on and macula-off groups, the FAZ area was comparable with controls. In the macula-on group, VD in the whole SCP was lower compared with controls at both baseline (p &lt; 0.001) and 6 months (p = 0.03), but showed a significant increase after surgery (p = 0.004). In the macula-off group, postoperative VD in both whole SCP and whole DCP was lower compared with controls (p &lt; 0.001). In the macula-on group, there was an inverse correlation between axial length increase and SCP VD change (r = -0.508; p = 0.03). These findings demonstrated microvascular alterations after SB for RRD. However, VD impairment seems to be mitigated after surgery. A greater increase in postoperative axial length was associated with a poorer VD outcome.

Long-Term Follow-Up of Macular Perfusion Evaluated by Optical Coherence Tomography Angiography after Rhegmatogenous Retinal Detachment Surgery.

The goal of this study was to investigate macular microvascular changes using optical coherence tomography angiography (OCTA) at one year after successful rhegmatogenous retinal detachment (RRD) surgery. We performed a cross-section study including RRD treated by pars plana vitrectomy (PPV) with or without scleral buckling and SF6 tamponade. After 12 months, DRI-Triton SS-OCTA was performed. Superficial and deep retinal capillary plexuses (SCP and DCP), choriocapillaris (CC) vessel density (VD), and foveal avascular zone (FAZ) morphology were analyzed. Results were compared with the unaffected contralateral eye. Sixty eyes were included. We observed an increase in VD in the central area of both the SCP and DCP in macula-off eyes treated with PPV + SB and in the SCP of macula-off eyes treated with PPV. Macula-off eyes had a diminished VD for both plexuses in the superior quadrant and in the SCP inferior quadrant in those treated with PPV + SB. The CC flow was diminished in the temporal quadrant of macular-off eyes treated with PPV + SB. Healthy eyes presented higher diameter values than macula-off eyes treated with PPV + SB. FAZ horizontal and vertical diameters were smaller in patients with macula-off RRD vs. macula-on RRD and control groups. Macular vascularity remains almost unchanged one year after successful RRD surgery, irrespective of the surgical technique or prior macular status.

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

Simple SummaryPrimary rhegmatogenous retinal detachment is an acute threat to visual impairment due to a retinal break that allows the passage of vitreous fluid into the subretinal space. Although it is clear that functional results are influenced by retinal detachment extension and surgical timing, we do not have definitive indications on post-operative changes in macular microcirculation and how they might affect visual performance. The study aims to evaluate the long-term macular vascular changes and their correlation with functional recovery in patients successfully treated for rhegmatogenous retinal detachment. We found a reduction of the vascular density in the operated eyes, not influenced by surgical techniques, independently from the pre-operative detachment extension. However, we found that functional recovery is influenced by different intraoperative choices. In conclusion, such visual acuity and microvascular changes can be considered biomarkers that highlight the relevance of careful management of this sight-threatening disease.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.