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Jose-Carlos Pastor, Itziar Fernandez, Melissa Castrejon, Jimena Rojas Spano, Rosa Coco, MRosa Sanabria, Enrique Rodriguez de la Rua; Visual loss in retinal detachment and macula-on after successful surgery, Retina 1 project. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2862.
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There is a clinical impression that some patients loose visual acuity (VA) after successful retinal detachment (RD) surgery and it has been attributed to macular involvement. However some patients with macula-on lose VA and there are no reports in the literature. The objective of this study is to analyze its incidence and identify the clinical factors related to VA loss in RD and macula-on who were successfully operated.
In a series of 1,047 rhegmatogenous RD (Retina 1 project) from a collaborative project between 17 Spanish and 2 Portuguese centers, we identified 53 out of 356 with macula-on at the admission for surgery who presented a visual loss (14.9%) after 3 months of successful surgery. Only patients with reattached retina were considered. RD with proliferative vitreoretinopathy (PVR) grades C or higher were excluded. VA was estimated at admission and at the 3rd month of follow-up. 83 clinical characteristics pre, intra and postoperative were evaluated. No OCT was performed.
Series were divided in: whole macula-on (group 1), phakic eyes with visual loss (group 2; n.39) and pseudophakic eyes with VA loss (group 3; n: 14). In group 1 initial VA was 0.55 (± 0.3) and 0.6 (± 0.29) at 3 months (p>0.1). Among group 1, 248 were phakic and 108 pseudophakic. VA in phakic patients was 0.56 (± 0.31) and 0.59 (± 0.29); in pseudophakic 0.57 (± 0.29) and 0.59 (±0.3); In group 2 VA was 0.65 (± 0.25) and 0.23 (± 0.14) (p<0.01). VA in group 2 was 0.64 (± 0.25) and 0.24 (± 0.14) (p<.01). Group 3 had a VA of 0.66 (± 0.26) and 0.21 (± 0.15). At initial examination, no signs of PVR were present in 56.9% of group 1; 45.3% in group 2 and 35.7% in group 3 (p<0.05). Vitrectomy (ppv) was performed in 67.2% of group 1; 88.7 % of cases in group 2 and 92.9% in group 3 (p<0.05). Scleral bands were performed in 57.7% in group 1; 58.5% in group 2 and 42.9% in group 3 (p<0.05 for groups 2&3). No statistical differences were found in any other pre, intra or postoperative clinical characteristics.
Around 15% of macula-on RD patients loose VA although successful surgery. Because ppv is the most frequent surgery, induced cataracts could be an explanation in phakic cases. But 13 % of pseudophakic also showed VA loss. In these cases another explanation is required. Further investigations would elucidate whether causes are anatomical changes or influence of some factors released by the detached retina.
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