Vitrectomy For Macula-off Retinal Detachment Research Articles

Perfluorocarbon liquid use during vitrectomy for macula-Off Retinal detachment has no impact on Macular folds and Metamorphopsia.

To compare two drainage techniques in macula-off retinal detachment (RD) surgery: perfluorocarbon liquid (PFCL)-assisted drainage and partial subretinal fluid (SRF) drainage without PFCL. We investigated morphological and functional outcomes, focusing on metamorphopsia quantification. Eighty eyes with macula-off RD were retrospectively included. All underwent a 25-gauge pars plana vitrectomy. In the PFCL group, SRF drainage was performed using PFCL. In the partial SRF drainage (SRFD) group, SRF was partially drained through a pre-existing retinal break without PFCL. A follow-up at 3 and 6 months evaluated anatomical outcomes using optical coherence tomography (OCT), best corrected visual acuity (BCVA) and metamorphopsia quantified with M-charts. Reattachment rates were comparable in the PFCL group (97.5%) and the SRFD group (95%) (p > 0.05). Mean BCVA (LogMAR) was 0.23 ± 0.32 (PFCL group) and 0.15 ± 0.13 (SRFD group) (p = 0.206). Metamorphopsia were reported by 19 patients (47.5%) in the PFCL group and by 12 patients (30%) in the SRFD group (p = 0.332). The mean metamorphopsia score was similar in both groups (0.27 ± 0.12 in the PFCL group and 0.28 ± 0.11 in the SRFD group, p = 0.866). Morphological OCT findings were comparable in both groups. Morphological and functional outcomes were similar in PFCL and SRFD groups. Metamorphopsia quantification scores did not improve with PFCL. While both of these techniques might be effective and could be recommended for primary macula-off RD management, potential PFCL toxicity should be kept in mind and its use dedicated to selected cases.

Characteristics of patients with complete visual acuity recovery after vitrectomy for macula-off retinal detachment.

The purpose of this study is to investigate potential factors predicting complete recovery of visual acuity following surgery for macula off retinal detachment (RD). Retrospective review of patients operated for macula-off RD at Jules-Gonin Eye Hospital between January 2015 and December 2016. The study included patients with visual acuity recovery of 0 LogMAR. A control group of 83 patients with comparable baseline characteristics but partial recovery of visual acuity after vitrectomy for macula-off RD was used for statistical comparison analysis. Seventy-four patients, 46 males (62%) and 28 females (38%), were included. Mean age was 65 years (standard deviation: 12). Median follow-up was 6 months (interquartile range: 3). Fifty patients (68%) were pseudophakic. Median pre-op best-corrected visual acuity (BCVA) was 2 LogMAR (interquartile range: 1.22). Forty-three of the patients (58%) had preoperative BCVA equivalent of count fingers or less. The majority of the patients (91%) had up to 3-day duration of macular detachment (MD) before surgery. In comparison only 18% of the group of patients with partial recovery of visual acuity after vitrectomy for macula-off RD had been operated within 3 days of MD (p < 0.0001). In 63% of the 40 cases in whom an optical coherence tomography (OCT) of the fovea could be interpreted, OCT image showed a retained foveal depression of the detached retina, whereas only 35% of the 46 control eyes with adequate OCT imaging showed a retained foveal depression (p = 0.01). In our study, patients had significantly better chances of complete visual acuity recovery when operated within 3 days of MD in comparison to more delayed surgery. Additionally, preservation of the foveal depression of the detached retina appeared to be a common characteristic among patients demonstrating complete visual recovery.

Morphologic and Functional Assessment of Photoreceptors After Macula-Off Retinal Detachment With Adaptive-Optics OCT and Microperimetry

Limited information is available on morphologic and functional regeneration of photoreceptors after retinal detachment (RD) surgery. This observational clinical study compared morphologic and functional changes of cones after vitrectomy for macula-off retinal detachment. Prospective, fellow-eye comparative case series. StudyPopulation: Five eyes after vitrectomy with gas for macula-off retinal detachment (retinal detachment eyes, RDE) and 5 healthy fellow eyes (HFE) of 5 patients (mean age 59.8 years, macula-off duration 0.5days to 5.5days). ObservationProcedures: Eyes were examined with adaptive-optics optical coherence tomography (AO-OCT), spectral-domain OCT (SDOCT), and microperimetry (MP) at 6 (baseline, BL) and 56weeks (follow-up, FUP) after 23 gauge pars plana vitrectomy and SF6 gas tamponade. Eight corresponding regions at foveal eccentricities of 2.5° (ecc 2.5°) and 6.5° (ecc 6.5°) were analyzed in every eye. AO-OCT en face images and SD-OCT B-scans were graded regarding irregularity and loss of photoreceptor signals ranging from none to severe changes. The number of detectable cones at height of the inner-outer segment junction (IS/OS) and cone outer segment tips (COST) was counted manually in AO-OCT images. MP with a custom grid was used to assess retinal sensitivity at these locations. MainOutcomeMeasures: Cone density, cone pattern regularity and signal attenuation, retinal sensitivity. In comparison to HFE, RDE showed highly irregular cone patterns in AO-OCT and irregular outer retinal bands in SDOCT. Despite significant improvement of cone pattern regularity compared to BL (P < .001), 63% of AO images showed remaining cone pattern irregularity and 45.5% of SDOCT B-scans showed severe signal reduction at FUP. In HFE, mean cone density retrieved from IS/OS and COST remained around 20,000/mm2 (ecc 2.5°) and 16,000/mm2 (ecc 6.5°) at BL and FUP. Cone density of RDE was significantly reduced and ranged between 200/mm2 and 15,600/mm2 (P < .001) at BL. Despite improvement at FUP (P < .001), mean cone density at IS/OS and COST was still lower compared to HFE and ranged between 7790 and 9555 cones/mm2 (P < .001). Mean retinal sensitivity of all measured locations remained 18 dB in HFE and was significantly lower in RDE, with 14.30 dB at BL and 14.64 dB at FUP. Both SDOCT grading and microperimetry sensitivity showed strong correlation with AO-OCT grading and cone density (rho values > 0.750). The combination of AO-OCT, SDOCT, and microperimetry is a powerful tool to capture cone regeneration after vitreoretinal surgery. Our study shows that cone morphology and function improve within 56weeks after RD surgery but structural and functional impairment is still present.

Retinal Sensitivity before and after Silicone Oil Removal Using Microperimetry.

The purpose of the study is to assess the retinal sensitivity, using microperimetry, before and after silicone removal. It included 22 patients admitted for silicone removal after vitrectomy for macula-off retinal detachment. Patients were divided into 2 groups according to the duration of silicone tamponade: Group A: <3 months (included 10 patients), and Group B: 3–6 months (included 12 patients). Retinal sensitivity was tested, using microperimetry, one day before and one month after silicone removal. The best-corrected visual acuity (in LogMAR) significantly improved postoperatively (0.69 versus 1.06 and 0.69 versus 1.07 in Groups A and B, respectively). The mean intraocular pressure (IOP) was 12.89 ± 1.05 mmHg postoperatively versus 14.89 ± 1.76 mmHg preoperatively in Group A (p=0.011) and was 13.33 ± 1.30 mmHg postoperatively versus 15.33 ± 3.11 mmHg preoperatively in Group B (p=0.008). In Group A, the mean postoperative overall retinal sensitivity was 8.70 ± 2.56 dB versus 5.68 ± 2.00 dB preoperatively (p=0.008). In Group B, it was 9.83 ± 3.36 dB versus 7.00 ± 2.55 dB (p=0.002). No statistically significant difference was found between the two groups as regards improvement in overall retinal sensitivity. We concluded that the overall retinal sensitivity significantly increased following silicone removal in both groups. This trial is registered with ISRCTN43187564.

Photoreceptor Inner and Outer Segment Junction Reflectivity after Vitrectomy for Macula-Off Rhegmatogenous Retinal Detachment

Purpose. To evaluate the spatial distribution of photoreceptor inner and outer segment junction (IS/OS) reflectivity changes after successful vitrectomy for macula-off retinal detachment (PPV-mOFF) using spectral domain optical coherence tomography (SdOCT). Methods. Twenty eyes after successful PPV-mOFF were included in the study. During a mean follow-up period of 15.3 months, SdOCT was performed four times. To evaluate the IS/OS reflectivity a four-grade scale was used. Results. At the first follow-up visit the IS/OS had very similar reflectivity in entire length of the central scan with total average value of 1,05. At the second visit the most significant increase of the reflectivity was observed in temporal and nasal parafovea with average values of 2,17 and 2,22, respectively. The third region of increased reflectivity of an average value of 2,33 appeared during the third follow-up visit and was located in the foveola. At the last follow-up visit in entire central cross section the IS/OS reflectivity exceeded grade 2 reaching the highest average values in nasal and temporal parafovea and foveola. Conclusions. A gradual increase of the IS/OS reflectivity was observed in eyes after PPV-mOFF. The process is not random and starts independently in the peripheral and central part of the macula which may be attributed to the variable regenerative potential of cones and rods.

Foveal Reattachment After Scleral Buckling vs Vitrectomy for Macula-Off Retinal Detachment

Purpose: To compare the time course of foveal reattachment after successful surgery for macula-off retinal detachments by scleral buckling or pars plana vitrectomy (PPV). Methods: We retrospectively examined, using optical coherence tomography (OCT), the cross-sectional retinal images of 28 patients who underwent scleral buckling or PPV for macula-off retinal detachment and whose retinas reattached upon binocular stereoscopic indirect ophthalmoscopy within 4 weeks postoperatively. All eyes underwent clinical examination and OCT scan of the macula at 6 weeks after surgery. If subretinal fluid persisted, repeated OCT was obtained at every 12 months until no abnormality was seen on OCT. Demographic data, including detachment characteristics, was also analyzed. Results: On postoperative OCT examination 6 weeks after surgery, complete foveal reattachments were detected in 14 patients (73.7%) in the PPV group (n=19), significantly higher than 3 (33.3%) patients in the buckling group (n=9). Foveal reattachment took a mean 8.315.25 weeks in the PPV group and a mean 20.8911.37 weeks in the buckling group. Conclusions: Foveal reattachment after macula-off retinal detachment occurred faster after PPV than after buckle surgery.