Persistent subretinal fluid after successful scleral buckle surgery for macula-off retinal detachment

Background After successful scleral buckle and cryotherapy for macular-off retinal detachment （RD）, some patients have poor visual acuity without any clinically detected macular change, and the unsatisfactory postoperative visual acuity is difficult to explain. The purpose of this study was to determine the characteristics of subretinal fluid （SRF） after successful scleral buckle surgery for macula-off RD. Methods Twenty-eight eyes from 28 patients were included in this study. The patients underwent scleral buckle surgery combined with cryopexy for macular-off RD. After surgery, all eyes underwent thorough ophthalmologic examinations including slit-lamp biomicroscopy, best-corrected visual acuity （BCVA） test, and binocular indirect ophthalmoscopy. The BCVA prior to the operation, duration of RD, the duration of postoperative retinal reattachment, BCVA when SRF was observed, period required for the SRF to become undetectable, and the BCVA at the final follow-up were included in the clinical data for this study. Optical coherence tomography （OCT） and B-ultrasonography were used to confirm SRF, and fluorescein angiography （FFA） was carried out in several patients. BCVA when SRF was observed and BCVA at the final follow-up were evaluated using a paired t test. Correlations between BCVA before the operation and duration of RD and BCVA at the final follow-up were analyzed using the Pearson correlation test. The type of SRF under OCT and BCVA at the final follow-up were compared using one-way analysis of variance （ANOVA）. Results Postoperative retinal reattachment was achieved in 1.0-7.0 days （average, （2.7±.2.1） days）. After retinal reattachment, SRF was detected in all eyes by OCT 2 weeks postoperative, while B ultrasonography found no changes. The mean IogMAR BCVA was 0.35±0.27 at the time of the detection of SRF. The period for SRF to become undetectable ranged from 2.0 to 11.0 months （average, （6.3±2.3） months）. The time of follow-up ranged from 24.0 to 36.0 months （average, （28.9±3.4） months）. The mean IogMAR BCVA improved to 0.30±0.23 at the final follow-up, which was significantly different from the mean IogMAR BCVA at the time of SRF detection （paired t-test, t=3.82, P 〈0.05）. Postoperative OCT images were classified into three categories. FFA was carried out in 10 eyes and revealed no leakage or strain in the lesions. BCVA before the operation was significantly correlated with BCVA at the final follow-up （r=0.56, P 〈0.05）. No significant correlation was observed between BCVA at the final follow-up and duration of RD （r=0.23, P=0.22）. One-way analysis of variance （ANOVA） showed no significant difference between the type of SRF under OCT and BCVA at the final follow-up （F=0.21, P=0.81）. Conclusions The presence of persistent SRF after successful scleral buckle surgery for macular-off rhegmatogenous RD may influence the BCVA or anatomic attachment. SRF was detected in all eyes by OCT at 2 weeks after the operation Residual detachment persisted for almost a year after surgery in certain patients. Fluorescein angiography revealed no leakage or strain in the lesions.

Epiretinal membrane following pars plana vitrectomy for rhegmatogenous retinal detachment repair

AIM: To determine the rate and possible contributors for post-pars plana vitrectomy(PPV) epiretinal membrane(ERM) in patients treated for rhegmatogenous retinal detachment(RRD). METHODS: This prospective, nonrandomized study comprised 47 consecutive patients(47 eyes) with acute RRD treated with 23 G post-PPV. All participants were followed prospectively for 6 mo for the development of ERM using spectral domain optical coherence tomography. Preoperative and intraoperative data were collected by questionnaires to surgeons. Main outcome measure was the percentage of the ERM formation following post-PPV for RRD. RESULTS: ERM developed postoperatively in 23 eyes(48.9%), none necessitated surgical removal. There was a statistically significant difference between patients with and without ERM postoperatively in preoperative best corrected visual acuity(median log MAR 1.9 vs 0.3, respectively;P=0.003) rate of macula-off(69.6% vs 37.5%, respectively, P=0.028), and rate of ≥5 cryo-applications(55.6% and 18.8%, respectively, P=0.039). ERM developed mainly between the 1st and 3rd months of follow-up. Macula-off status increased the risk of ERM, with the odds ratio of 3.81(P=0.031). CONCLUSION: ERM is a frequent post RRD finding, and its development is associated with macula-off RRD.

累及黄斑视网膜脱离术后解剖学改变和功能恢复情况(英文)

目的:OCT观察累及黄斑视网膜脱离行巩膜外加压术后5a黄斑情况。分析脱离时间及术后5a黄斑OCT及视功能的相关性。方法:回顾性分析47例47眼,累及黄斑视网膜脱离行巩膜外加压术后5a OCT,视功能及脱离时间,并行统计学分析。结果:视网膜脱离时间<7d的黄斑厚度(226±88μm)较脱离时间>7d黄斑厚度(209±76μm)厚,但无统计学意义。而术后复位的黄斑厚度和视力呈正相关(Pearson correlation test,R=1,P=0.01)。脱离时间<7d组视力(0.53)明显好于脱离时间>7d组视力(0.25),明显统计学差异(ttest,P=0.008)。5例(10%)患者发现黄斑区结构异常,包括4例IS/OS层断裂,同时伴有外界膜的断裂(8.5%),且术后5a平均视力(0.15)低于两组的平均视力。结论:脱离时间的长短严重影响视功能的恢复、术后黄斑的厚度及黄斑结构的改变。累计黄斑视网膜脱离手术尽可能在脱离时间<7d内完成。对于视力恢复较差者,建议行OCT检查。