Elsevier

Ophthalmology

Volume 113, Issue 7, July 2006, Pages 1179-1183
Ophthalmology

Original Article
Optical Coherence Tomography Analysis of the Macula after Vitrectomy Surgery for Retinal Detachment

Presented at: American Academy of Ophthalmology Annual Meeting, October, 2004; New Orleans, Louisiana.
https://doi.org/10.1016/j.ophtha.2006.01.039Get rights and content

Objective

To define the incidence, duration, and clinical associations of persistent localized submacular fluid after pars plana vitrectomy (PPV) retinal detachment surgery.

Design

Observational cohort series.

Participants

One hundred patients were identified and recruited into the study.

Methods

Patients aged 18 years and older who had undergone PPV and gas as a primary procedure for rhegmatogenous retinal detachment and postoperative follow-up were recruited from February through August 2004. All patients underwent clinical examination, optical coherence tomography (OCT) scan of the macula, and retinal thickness analysis scan of the macula. Those patients in whom an abnormality was seen on OCT at 6 weeks after surgery underwent follow-up with repeat of the study investigations at 3, 6, 9, 12, and 18 months after surgery until the abnormality resolved. If no abnormality was seen at the 6-week examination, no further investigation was undertaken. Demographic data, including detachment characteristics, were collected retrospectively from the patient case notes.

Main Outcome Measures

The principle outcome measure was the presence of subretinal fluid (SRF) on OCT at 6 weeks after surgery. Other outcome measures included duration of persistent fluid and association with visual outcome and type and duration of detachment.

Results

One hundred patients were recruited; 15 of these had SRF on OCT performed at 6 weeks after surgery. Subretinal fluid was associated with significantly worse visual acuity (VA) at 6 weeks (P = 0.033, Wilcoxon rank-sum); those with SRF had a median VA of 0.4, and those with no SRF had a median VA of 0.3. The fluid took a median of 5.5 months to resolve. Seven patients had combined PPV and scleral buckle surgery; none of these had fluid at 6 weeks.

Conclusions

Optical coherence tomography is a useful noninvasive diagnostic method that can detect SRF not appreciated on clinical examination. Persistent SRF after PPV and gas surgery occurred in 15% of patients in this study and was still present in 53% of these at 6 months. The presence of SRF at 6 weeks after surgery was associated with a poorer visual outcome at this time point.

Section snippets

Patients and Methods

Consecutive patients undergoing outpatient review at 6 weeks after pars plana vitrectomy surgery for uncomplicated primary rhegmatogenous retinal detachment were recruited to the study. Patients with preexisting macular pathologic features (e.g., age-related macular degeneration) likely to influence imaging and visual outcome were excluded from the study. Patients underwent best-corrected visual acuity assessment as measured on an Early Treatment of Diabetic Retinopathy Study chart, pin-hole

Results

One hundred patients were recruited to the study. Table 1 shows demographic data (type of retinal detachment, clock hours of detachment, etc.). At the 6-week investigation, 15 patients had persistent SRF on OCT (Table 2). Patterns of SRF were defined according to those noted in our previous investigation on scleral buckle patients as either confluent fluid, single, or multiple blebs (Benson et al, unpublished data). In this study, we noted that most of those affected had a single bleb of fluid,

Discussion

Optical coherence tomography can detect SRF not appreciated on clinical examination in patients having undergone vitrectomy and gas procedures for retinal detachment. Subretinal fluid was seen in 15 of 100 patients at 6 weeks, was associated with worse VA at this time point, and was seen clinically in only 8 of these 15. The presence of fluid did not seem to be associated with the patient demographics or characteristics of retinal detachment other than macular involvement.

The incidence of

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Manuscript no. 2005-751.

The authors have no conflicting relationships.

Supported by Pfizer, Inc., New York, New York.

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