Rhegmatogenous Retinal Detachment Eyes Research Articles

Suprachoroidal Space in Rhegmatogenous Retinal Detachment Assessed with Optical Coherence Tomography: Implications for Potential Future Therapeutic Interventions.

To comprehensively investigate the suprachoroidal space (SCS) in the context of rhegmatogenous retinal detachment (RRD) using swept-source optical coherence tomography (SS-OCT). We conducted a post hoc analysis of 90 consecutive patients with a primary RRD. Baseline SS-OCT scans were graded for the presence and thickness of the suprachoroidal space. Available scans of the fellow eye were graded for comparison. The suprachoroidal space was visible in 31.6% (24/76) of gradable RRD scans, with a mean thickest location measuring 67.0µm (SD 25.9), mean thinnest location of 33.8µm (SD 11.1), and mean average thickness of 50.0µm (SD 16.8). Additionally, the SCS was detectable in 28.3% (13/46) of available fellow eye scans, with a mean thickest location measuring 47.0µm (SD 41.7), thinnest location of 25.2µm (SD 27.6) and mean average thickness of 35.8µm (SD 31.4). A statistically significant difference was found between RRD and fellow eyes in all measurements of SCS thickness. In RRD, the suprachoroidal space serves as a crucial fluid reservoir influenced by dynamic shifts in intraocular hydrostatic and oncotic pressures. We found significant SCS engorgement in RRD eyes compared to fellow eyes, which may facilitate intra-SCS therapies such as suprachoroidal viscopexy (SCVEXY) or other pharmacologic interventions.

Optical coherence tomography angiography based prognostic factors and visual outcomes in primary rhegmatogenous retinal detachment after pars plana vitrectomy

PurposeTo evaluate the visual outcomes and changes in the retinal microcirculation in patients with primary rhegmatogenous retinal detachment (RRD) following successful pars plana vitrectomy (PPV).MethodsNine macula-on RRD and 23 macula-off RRD eyes were retrospectively evaluated. Clinical data was collected at admission and 3 months after PPV. Optical coherence tomography angiography (OCTA) was performed 3 months after PPV. Superficial vascular plexus data obtained with OCTA was compared between affected and fellow eyes and according to macular involvement. Quantitative measurements of the superficial retinal capillary associated with the preoperative and intraoperative factors were analyzed.ResultsOverall RRD inner vessel densities (IVD), full vessel densities (FVD), inner perfusion densities (IPD) and full perfusion densities (FPD) were significantly and positively correlated with best corrected visual acuity (BCVA)(p = 0.002, p = 0.006, p = 0.009, p = 0.023, respectively). In the macula-off RRD, IVD and FVD were significantly decreased compared with macula-on RRD (p = 0.014 and p = 0.034, respectively) and significantly correlated with a longer duration and larger extension of detachment. Higher differences of IVD and FVD between the fellow and affected eyes were significantly correlated with worse BCVA in the macula-off subgroup.ConclusionMacula-off RRD presented worse OCTA superficial vascular parameters compared with the macula-on group and fellow eyes, which were correlated with a poorer visual outcome and exacerbated by a longer duration and larger extension of the detachment. Macula-off RRD causes not only retinal structural damage but also a reduction in retinal perfusion despite successful anatomical repair.

Clinical characteristics and optical coherence tomography of concomitant macular hole and rhgematogenous retinal detachment

To study the clinical characteristics of macula off rhegmatogenous retinal detachment (RRD) with peripheral causative breaks and concomitant macular hole (RRD+MH). This is a bi-center study. Consecutive eyes of macula off RRD with or without macular hole (MH) were collected. Eyes in these two groups were compared with best corrected visual acuity in logarithm of minimal angle of resolution (logMAR BCVA), the presence of choroidal detachment (CD), proliferative vitreoretinopathy (PVR) and the extent of RRD. In the group of RRD+MH, regression analysis was used to evaluate the correlation of clinical factors and final logMar BCVA. In addition, optical coherence tomography was performed both pre-and post-operatively if possible. There were 40 eyes in the RRD+MH group and 80 eyes in the control group. Eyes with RRD+MH had worse initial and final logMar BCVA (p < 0.001), higher incidence of CD (p < 0.001), PVR and extensive RRD at baseline (p < 0.001). Among the eyes with RRD+MH, final BCVA was correlated with initial BCVA (p < 0.001, CI 0.637 to 0.837), recurrent RRD (p = 0.004, CI − 0.661 to − 0.126), duration of RRD (p = 0.021, CI − 0.576 to − 0.048) and presence of PVR (p = 0.001, CI − 0.131 to − 0.035). The hole closure rate at final follow up is 87.5%.11 of the 17 eyes had preoperative optical coherence tomography (OCT) obtained had ellipsoid zone lining the bottom of MH. CD, PVR and extensive RRD were more commonly observed in RRD+MH. The morphology of MH may suggest the pathogenesis of MH in RRD+MH include mechanism different from that of idiopathic MH.

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

Objective: To analyze the performance of custom semi-automated software for quantitative analysis of retinal capillaries in eyes with macula-off rhegmatogenous retinal detachment (RRD) and the role of these microvascular measures as potential biomarkers of postoperative visual outcomes. Methods: A prospective, observational, and single-center study was conducted on consecutive patients who underwent 25G pars-plana vitrectomy for primary uncomplicated macula-off RRD. Optical coherence tomography angiography (OCTA) was performed in the fellow and RRD eyes before surgery and in months 1, 3, and 6 after surgery. The preoperative values of the fellow eyes were used as surrogates of macula-off ones. The primary endpoints were the mean vessel diameter index (VDI); vessel area density (VAD); and vessel skeleton density (VSD) at month 6. Results: Forty-four eyes (44 patients) were included in the study. Considering the fellow eyes as a surrogate of preoperative values of macula-off eyes, VDI in superficial (SCP) and deep (DCP) capillary plexuses was significantly reduced at month 6 (p = 0.0087 and p = 0.0402, respectively); whereas VSD in SCP increased significantly from preoperative values (p = 0.0278). OCTA built-in software parameters were significantly reduced from month 1 to month 6 in both SCP and DCP (p values ranged between 0.0235 and <0.0001). At month 6, 25 (56.8%) eyes achieved a best-corrected visual acuity BCVA ≥ 0.3 (LogMAR). The greater the preoperative BCVA, the greater the probability of achieving good visual outcomes (Odds ratio: 11.06; p = 0.0037). However, none of the OCTA parameters were associated with the probability of achieving a BCVA improvement ≥ 0.3. Conclusions: Quantitative evaluation of capillary density and morphology through OCTA and semi-automated software represents a valuable tool for clinical assessment and managing the disease comprehensively.

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.].

Rhegmatogenous retinal detachment in highly myopic eyes with implantable collamer lens.

To investigate the clinical characteristics, treatment methods and outcomes of rhegmatogenous retinal detachment (RRD) in highly myopic eyes with implantable collamer lens (ICL). High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed. Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient. A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included. The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo (range, 1-60mo). At the initial visit for RRD, giant retinal tear (GRT), horseshoe tear, simple round hole, and horseshoe tear combined with round hole were detected in 3, 3, 2, and 1 eye(s), respectively, with macula-off in eyes. Eight patients received surgical treatment, and one patient was treated by retinal laser photocoagulation alone. The ICL was preserved in 7 eyes. At the last follow-up, the mean best corrected visual acuity (BCVA) improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR (P=0.035), and no case of recurrent retinal detachment was found. The morphological presentation of retinal breaks is diverse in this study. The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data, companied with acceptable visual and anatomical outcomes.

Evaluation of retinal structural and functional changes after silicone oil removal in patients with rhegmatogenous retinal detachment: a retrospective study

BackgroundTo evaluate retinal structural and functional changes after silicone oil (SO) removal in eyes with macula-off rhegmatogenous retinal detachment (RRD).MethodsBest-corrected visual acuity (BCVA) testing, microperimetry, and optical coherence tomography angiography were performed in 48 eyes with macula-off RRD before and 3 months after SO removal. The values of healthy contralateral eyes were used as control data. Correlations between retinal vessel density (VD), retinal nerve fiber layer thickness (RNFLT), the interval between retinal detachment and surgery, the duration of SO tamponade, the follow-up time after SO removal, and visual function were analyzed.ResultsSignificant increases in 2˚ fixation rate (FR), 4˚ FR, 2˚ mean retinal sensitivity (MRS), 6˚ MRS, parafoveal superficial capillary plexus VD and RNFLT were observed after SO removal (all P < 0.05). The increase of 2˚ MRS and 6˚ MRS were correlated with the duration of SO tamponade and the follow-up time after SO removal respectively (all P < 0.05). The last 2˚ MRS and 6˚ MRS were correlated with the duration of SO tamponade, the interval between retinal detachment and surgery, and the follow-up time after SO removal (all P < 0.01). The last FR in RRD eyes was close to that of contralateral eyes (P > 0.05).ConclusionRetinal structure and function improved to different degrees after SO removal. Fixation stability and retinal sensitivity increased more than BCVA postoperatively. Retinal sensitivity, which was affected by the interval between retinal detachment and surgery and the duration of SO tamponade, gradually recovered after SO removal.

Changes of optical coherence tomographic hyperreflective foci in rhegmatogenous retinal detachment patients after successful surgery

PurposeTo assess the changes of hyperreflective foci (HRF) in rhegmatogenous retinal detachment (RRD) patients after successful reattachment surgery. MethodsTwenty-nine macula-off RRD eyes with successful reattachment surgery were retrospectively analyzed. Optical coherence tomography (OCT) was used to image macular regions and measure HRF in outer retina and inner retina at 0.5, 1, 3, 6, 12 months after surgery. The relationships between HRF and photoreceptor layer status, visual outcomes were evaluated. ResultsAfter retinal reattachment, HRF mainly distributed at the location where external limiting membrane (ELM) or inner and outer segment (IS/OS) line was disrupted. The HRF numbers in outer and inner retina were greater in eyes with discontinuous IS/OS line than eyes with continuous IS/OS line (all p<0.05). In the outer retina, HRF increased in the initial three months after retinal reattachment, and then decreased gradually after 3 months (p<0.05). The HRF number in the outer retina at postoperative 0.5 months was associated with favorable visual outcomes at 6 and 12 months (r=-0.487, p =0.025; r=-0.626, p=0.005, respectively), nevertheless, the HRF number at 3 months was correlated with poor visual results at 6 and 12 months (r=0.441, p =0.017; r=0.477, p=0.019, respectively). ConclusionHRF mainly occurred near the site where ELM or IS/OS line was injured after retinal reattachment. In the outer retina, the number of HRF gradually increased in the first 3 months and then gradually decreased. The early appearance of HRF in the outer retina was associated with a good visual prognosis, while the late appearance may suggest a less favorable visual outcome.

Long-term Comparison of Choroidal Thickness between Scleral Encircling and Combined with Trans-pars Plana Vitrectomy in Retinal Detachment

Purpose: To compare the subfoveal choroidal thickness (SFCT) before and after scleral encircling (SE), with or without trans-pars plana vitrectomy (TPPV), in patients with monocular primary rhegmatogenous retinal detachment (RRD).Methods: We retrospectively analyzed patients who underwent SE for monocular primary RRD between January 2019 and June 2021 and underwent optical coherence tomography during follow-up. SFCT was measured independently at three regions before the surgery and 1, 2, 3, and 6 months after the surgery. The values were manually analyzed by two independent ophthalmologists.Results: Of the 33 eyes included in the study, 18 (54%) underwent SE alone, while 15 (46%) underwent SE with TPPV. SFCT gradually decreased after surgery in all patients (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). The SFCT was significantly greater 6 months postoperatively in the SE alone group (260.51 ± 78.30 μm) compared to the SE with TPPV group (225.55 ± 75.24 μm) (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Macular detachment patients had significantly greater preoperative SFCTs (276.46 ± 20 μm) compared to others (223.93 ± 20 μm) (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Preoperative SFCT was significantly related to visual acuity (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), while the remaining SFCT values did not have any significant effects.Conclusions: In primary RRD eyes, SFCT decreased over time after SE, more so when TPPV was also performed. Further studies are required to investigate the mechanism of SFCT change and its impact on RRD.

Evaluation of the Effect of Scleral Buckling on Anterior Segment and Refractive Changes Using Anterior Segment Optical Coherence Tomography

ABSTRACT Purpose To evaluate the changes of anterior segment and refractive parameters after scleral buckling (SB) surgery for uncomplicated rhegmatogenous retinal detachment (RRD) using anterior segment optical coherence tomography (AS-OCT). Methods Thirty-six RRD eyes were consecutively enrolled. Analysis concerned the central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber volume (ACV), iris-trabecular contact (ITC), angel opening distance (AOD), angle recess area (ARA), trabecular-iris space area (TISA)，trabecular iris angle (TIA) and refractive parameters, including average keratometry (AvgK), cylindrical power (CYL), regular astigmatism, asymmetry and high order irregularity (HOI) at baseline and 1 day, 1 month, 2 months, 6 months and 12 months postoperatively. AS-OCT was performed at RRD diagnosis and day 1, week 1, month 1 and month 6 after SB to evaluate the scleral buckling. Results A statistically significant postoperative CCT increase, ACD and ACV decrease were observed at 1 day and 1 month postoperatively. ITC analysis showed that the angle of the entire circumference narrowed at 1 month postoperatively. There was a significant decrease in all the angle parameters (AOD500/750, ARA500/750, TISA500/750, and ARA500/750) at 1 day and 1 month after SB surgery. However, all of the above parameters returned to the preoperative level at 12 months. Refractive parameters including AvgK, regular astigmatism, CYL, asymmetry, and HOI of anterior corneal surface and total corneal increased on the 1 day and 1 month after SB surgery and persisted even after 12 months follow-up. However, there was no significant difference in refractive parameters of posterior corneal surface during follow-up. Conclusion The changes in the structure of anterior segments after SB surgery were almost returned to the preoperative levels at 12 months postoperatively. However, SB surgery has a long-term effect on refractive parameters throughout a 12-month follow-up.

Retinal detachment after post-operative endophthalmitis: clinical characteristics, outcomes and risk factors.

To describe clinical characteristics, risk factors, and outcomes of rhegmatogenous retinal detachment (RRD) following treatment of postoperative endophthalmitis (PE). Analysis of cross-referenced data from two service reviews of patients with RRD and bacterial PE treated between 01/01/2013 and 01/07/2020. The main outcome measure was final best-corrected visual acuity (BCVA). Secondary measures include proportion of patients with BCVA of ≤ 0.3 logMAR and ≥ 1.0 logMAR, rate of phthsis, and rate of eye removal. Ninety-four cases of PE were analysed finding 21 cases of RRD (22%). Seven (35%) experienced recurrent RRD. Seven eyes (35%) were left with permanent silicone oil fill. All RRD cases had vitrectomy. After PE with RRD the median BCVA was 1.1 logMAR, compared with 0.4 logMAR for PE without RRD (p < 0.04). Fifty-seven percent (12/21) of RRD eyes attained BCVA of ≥ 1.0 logMAR vs. 29% (21/73) of PE without RRD (p = 0.01). Nineteen percent (4/21) of eyes with RRD attained BCVA of ≤ 0.3 logMAR, whereas those without RRD did so in 43% (31/73) of cases (p = 0.02). Five eyes with RRD (24%) and 2 eyes without RRD (3%) developed phthisis (p < 0.01). Three non-RRD cases required removal of the eye (4%, p = 0.46). Higher bacterial virulence was associated with worse final BCVA (2.1 logMAR vs. 0.3 logMAR; p < 0.01). RRD rate did not differ by bacterial virulence (OR 1.9; CI95: 0.6-6.9; p = 0.24). RRD following PE leads to worse clinical outcomes. Eyes which developed RRD were more likely to have undergone vitrectomy. Final BCVA was worse in cases with more virulent micro-organisms.

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.

Vascular parameters after vitrectomy for rhegmatogenous retinal detachment, an optical coherence tomography angiography study

AbstractPurpose: To analyse vascular changes such as the postoperative foveal avascular zone (FAZ) area, the superficial vessel density (sVD) and deep vessel density (dVD) and their correlation with functional (best‐corrected visual acuity, metamorphopsia) and anatomical outcomes (foveal macular thickness, FMT) after surgery for rhegmatogenous retinal detachment (RRD) repair.Methods: Patients with RRD eyes, successfully treated with a single pars plana vitrectomy (PPV) with gas or silicone oil tamponade and a minimum 6 months follow‐up, were re‐examined. For patients where silicone oil was applied, measures were taken after its removal. Foveal avascular zone (FAZ) area, sVD, dVD and FAZ area were evaluated by using optical coherence tomography angiography (OCTA) and compared to fellow eye. Moreover, anatomical association was tested between areas of reported metamorphopsias and vascular changes in the corresponding area.Results: Twenty‐one patients with macula‐on and 24 with macula‐off RRD were included in the study. In both groups, no significant difference in macular thickness and FAZ area was found compared to fellow eyes. In macula‐on RRD eyes, a lower total dVD (p &lt; 0.05) was detected; FAZ area was not related to FMT, and the postoperative BCVA was correlated with total DVD (p &lt; 0.05) or FAZ area. In macula‐off RRD eyes, sDV (p = 0.012), and dVD (p = 0.05 and p &lt; 0.05, respectively) were observed when compared to fellow eyes. The prevalence of metamorphopsia in macula‐on group was 42.86% (9/21), whereas in macula ‐off this number increased to 62.5% (15/24). For both of these groups, we found significant association between sDV and presence of metamorphopsia but only in the inferior paramacular area (p = 0.01).Conclusions: Rhegmatogenous retinal detachment eyes successfully treated with PPV had lower vessel density in the superficial and deep retinal plexus compared to fellow healthy eyes; BCVA was related to vessel density but not FAZ area. Metamorphopsias were also related to lower vessel density inferiorly of the macula.

Characteristics of Bilateral Retinal Detachment

Introduction: Rhegmatogenous retinal detachment (RD) is still a sight-threatening and potentially blinding disease, especially if both eyes are affected. The purpose of this study is analysing the specific characteristics of bilateral rhegmatogenous RD. Methods: The files of all 5,791 consecutive eyes undergoing vitreoretinal surgery for uncomplicated RD in a single tertiary retinal centre between January 2005 and June 2021 were retrospectively reviewed. Results: A total of 300 patients (600 eyes) had bilateral retinal detachment. Interval between initial and subsequent RD surgery was 2.6 ± 2.8 (mean ± SD, median 1.5) years. Symptoms were reported by the patients for 20 ± 75 (median 5) days before presentation in the initial eye and 12 ± 32 (median 4) days in the subsequent eye. 220 patients were male (73%), and mean age at initial RD was 55 years. 183 (61%) of the initial RD eyes were phakic. In the initial eye, more patients had a detached macula, worse visual acuity, and more quadrants involved. Primary anatomic success rate was higher in the subsequent eye (90%) compared to the initial eye (83%). There was no difference in the reattachment rate of fellow eyes with primary failure in the first eye (91%) compared to those with primary success in the first eye (90%). There was a high symmetry between the eyes in terms of type of retinal break, number of breaks, and presumed localization of the causative retinal break. Conclusion: Patients with bilateral RD were more commonly male and younger than the group of all RD patients. The proportion of pseudophakia was not different. The majority of fellow eye RD occurred within 2 years after the RD in the first eye. Second eye RD was less advanced and had a better anatomical repair rate. Despite their experience in the first eye and despite typical symptoms, patients presented only after a mean of 12 days with RD in the second eye. RD in the initial and the subsequent eye showed a high symmetry. The anatomic result in the first eye is not a predictor for the anatomic result in the subsequent eye.

Changes of retinal ganglion cell complex after vitrectomy in rhegmatogenous retinal detachment patients and its correlation with inflammatory blood biomarkers

PurposeTo compare retinal ganglion cell complex (GCC) parameters between rhegmatogenous retinal detachment (RRD) eyes and normal contralateral eyes after vitrectomy and to evaluate their correlation with inflammatory blood markers.MethodsWe investigated 25 eyes that underwent vitrectomy due to RRD. Venous blood samples were collected from all participants before 08:00 a.m. on the second day of admission after a 12-hour fast for blood counts. The differences of retinal structure between RRD and contralateral eyes were compared 1 week postoperatively.ResultsFocal loss volume (FLV) (2.009 ± 1.286)% was significantly increased compared with the contralateral eyes (p < 0.001). Monocyte-to-high-density lipoprotein was significantly positively correlated with GCC thickness parameters, and negatively correlated with FLV and global loss volume (GLV). Postoperative best-corrected visual acuity was negatively correlated with GLV (p = 0.039, R2 = 0.172).ConclusionRetinal ganglion cells (RGCs) loss might present early postoperatively in RRD eyes, and was associated with systemic inflammation. RGCs loss might affect postoperative vision.

Association of Microvasculature Changes with Visual Outcomes after Successful Retinal Detachment Surgery

To evaluate macular microvascular changes and their correlation with visual outcomes after rhegmatogenous retinal detachment (RRD) surgery. Retrospective case series. The study included 74 eyes successfully operated for RRD. The foveal avascular zone area in the superficial capillary plexus, the vessel density (VD) in the superficial capillary plexus, vessel density deep capillary plexus (VD DCP), and choriocapillary plexus were evaluated using octangiography at 1 and 6 months postoperatively. The fellow eyes were used as controls for comparison. The correlation between octangiography parameters and postoperative best-corrected visual acuity (BCVA) was assessed using a hybrid linear mixed model. We also analyzed the relationship between octangiography parameters and the integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) of photoreceptors. The median VD 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, superficial capillary plexus, and choriocapillary plexus (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 VD DCP (P = 0.009) in multivariate analysis. Eyes with low 1-month VD DCP tended to have worse final BCVA (P = 0.067). There was no correlation between VD 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 VD DCP than those with disrupted ELM and/or EZ (P = 0.027). The VD DCP was affected in RRD eyes as well as strongly associated with postoperative BCVA and the restoration of photoreceptor layers. It might thus serve as a predictor for visual recovery following successful RRD surgery.

Rhegmatogenous retinal detachment induces more severe macular capillary changes than central serous chorioretinopathy

To investigate hemodynamic changes in macula-off rhegmatogenous retinal detachment (RRD) and its impact on visual prognosis by comparing with central serous chorioretinopathy (CSC). Using optical coherence tomography angiography (OCTA), vascular density in the superficial capillary plexus and deep capillary plexus (DCP) was retrospectively compared with that in contralateral unaffected eyes in macula-off RRD and CSC eyes. In RRD eyes, pre- and postoperative ultra-widefield (UWF) fluorescein angiography (FA) were obtained to analyze vascular changes. In OCTA, both macula-off RRD and CSC eyes showed less density in macular DCP, compared to the unaffected fellow eyes. Compared to CSC, eyes affected by macula-off RRD showed a reduction in DCP vascular density and an increase in foveal avascular zone area, although it had a much shorter macular detachment period. In macula-off RRD, less density of DCP was strongly correlated with longer duration of detachment, greater ellipsoid zone disruption, and poor visual recovery. In UWF-FA, detached retina showed capillary hypoperfusion, venous stasis and leakage, which were improved after reattachment. In conclusion, macular capillary loss of flow, which was associated with photoreceptor disruption, correlated with duration of detachment in RRD. Early reattachment and reperfusion are required for minimizing macular vasculature and photoreceptor damage in macula-off RRD.

Visual deterioration in patients with photoreceptor loss after retinal reattachment surgery

PurposeAssess the relationship between photoreceptor degeneration and visual function after retinal reattachment surgery (RRS) in a prospective cohort.MethodsPatients with rhegmatogenous retinal detachment (RRD) were reviewed before and 6 months after vitreoretinal surgery. Optical coherence tomographical thickness of the outer nuclear layer (ONL), outer retinal segment (ORS), retinal pigmented epithelium to ellipsoid zone (RPE-EZ) and external limiting membrane to EZ (ELM-EZ) were recorded 6 months post-operatively. These were compared to best corrected visual acuity (BCVA) and retinal sensitivity (Humphrey visual field).ResultsThirteen macula-off and 8 macula-on RRD patients were included. The mean ONL thickness was higher after macula-on RRD compared to macula-off RRD (97.70 ± 3.62 μm vs. 73.10 ± 4.98 μm). In all RRD eyes, every 1 μm decrease in ONL thickness correlated with a 0.052 dB decrease and in retinal sensitivity and every 1 μm decrease in ORS thickness was associated with a 0.062 dB reduction in retinal sensitivity. ORS, ELM-EZ and RPE-EZ thickness did not correlate with BCVA post-RRS.ConclusionThere was greater ONL and ORS thinning following macula-off compared to macula-on RRD. Correlations between ONL and ORS thinning with decreased retinal sensitivity may be explained by RRD-induced photoreceptor death.

Results of pars plana vitrectomy with inferior retinotomy in inferior rhegmatogenous retinal detachments with inferior retinal breaks and proliferative vitreoretinopathy grades B or C

AbstractPurposeTo report the surgical outcomes of pars plana vitrectomy (PPV) with inferior retinotomy without the need for scleral buckling in primary inferior rhegmatogenous retinal detachment (RRD) with inferior retinal breaks and Proliferative vitreoretinopathy (PVR) grades B or C.MethodsRetrospective, consecutive series, single‐center study of patients that underwent PPV with inferior retinotomy for primary inferior RRD with inferior retinal breaks (4:00 to 8:00 clock hours) and PVR grades B or C. Data were obtained from patients’ medical records from October 2014 to November 2020. The primary outcomes of the study were retinal reattachment and visual acuity improvement. Data collected before and after surgery was compared between groups using chi‐square analysis and paired samples t‐test. The resulting p‐values significance level was set at p = 0.05.ResultsThirty‐two patients (32 eyes) met the inclusion criteria. PVR in stage B was present in 19 patients and stage C in 13 patients. Macula‐off RRD was diagnosed in 25 patients while the other 7 patients had RRD with the macula attached. Regarding primary outcomes, 31 out of 32 (97%) patients achieved retinal reattachment with no differences between PVR groups (p = 0.406). The best‐corrected visual acuity (BCVA) improved significantly in eyes with macula‐off RRD at presentation (p &lt; 0.001). Although macula‐attached RRD eyes had higher final BCVA, its improvement was not statistically significant (p = 0.370). Besides one retinal redetachment, no other significant complications were reported after surgery.ConclusionsInferior retinal breaks are associated with surgical failure following PPV for inferior RRD repair, especially if advanced PVR is present. Our results suggest that, in these less common and more challenging cases, PPV with an inferior retinotomy is associated with very favorable anatomic and visual outcomes.

Macular microcirculation changes after macula-off rhegmatogenous retinal detachment repair with silicone oil tamponade evaluated by OCT-A: preliminary results.

Background:Rhegmatogenous retinal detachment (RRD) with macular involvement is a sight-threatening condition. Silicone oil (SO) is efficacious for retinal tamponade, especially in complex cases. Whether macular detachment per se or the potential tamponading agent may affect macular microcirculation after RRD repair is a matter of research.Objectives:To investigate macular microcirculation changes using optical coherence tomography angiography (OCT-A) after pars plana vitrectomy (PPV) with intravitreal SO for RRD repair in the early posttreatment period.Design:Prospective comparative cross-sectional study.Data sources and Methods:Fourteen eyes of 14 patients were included in the study. All eyes underwent a single successful PPV with SO tamponade for macula-off RRD. OCT-A was performed to analyze macular microcirculation and visual outcomes at 1 month postoperatively. The fellow unaffected eye was used as control.Results:Vessel density (VD) in the superficial capillary plexus (SCP) was significantly lower at each macular region (fovea, parafovea, and perifovea) of SO-treated eyes compared with the fellow eyes (all p = 0.001). Similarly, perfusion density (PD) in the SCP was significantly lower at each macular region than the fellow eyes (all p = 0.001). There was enlargement of foveal avascular zone (FAZ) area and decrease of circularity at RRD eyes compared with the fellow ones (all p = 0.001). Postoperative logMAR visual acuity (VA) was significantly lower in treated eyes than fellow eyes and correlated inversely with foveal, parafoveal, and perifoveal VD and PD SCP (all p < 0.001). Postoperative VA had no correlation with FAZ parameters.Conclusion:Enlargement of FAZ SCP and decrease in VD and PD SCP during the short-term follow-up were possibly attributable to ischemic changes in the macular area after RRD repair with SO tamponade. In this preliminary study, the flow density in macular capillary plexus may represent an indicator of visual outcomes.