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Alice Yang Zhang, Sulaiman Alhumaid, Aaron Rosen, Christina ryu, Michael Kapusta, John Galic, John Chen; Structural abnormalities of the macula as causes of incomplete recovery of vision post successful primary rhegmatogenous retinal detachment repair. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2307.
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To assess the visual outcome in patients with successful primary macula-off rhegmatogenous retinal detachment and to investigate the prevalence of macular structural abnormalities in those with poor visual outcome.
A retrospective chart review from McGill University’s surgical retina service was conducted, with prospective follow-up. Operative records from surgical repairs with the diagnosis of “retinal detachment” were reviewed, including pneumatic retinopexy, pars plana vitrectomy, scleral buckle or a combination of these. All patients with prior diagnosis of a maculopathy, serous or tractional retinal detachment, fovea-on or recurrent rhegmatogenous retinal detachment were excluded. Patients with at least a 6-month follow-up period were included.
152 patient charts were retrieved, of which 41 fulfilled the above criteria. Of these patients, at 6 months post-operatively, 24% had a visual acuity of 20/40 or better, 66% had a visual acuity worse than 20/40 but better than or equal to 20/200, and 10% had a visual acuity worse than 20/200. Of patients with decreased visual acuity (less than 20/40), excluding those with media opacity, structural macular pathologies were found on optical coherence tomography (OCT) in 56%. These macular abnormalities include: epiretinal membrane and/or cystoid macular edema (33%), persistent subretinal fluid (33%), macular hole (7%), and retinal atrophy and/or IS/OS disturbance (27%).
Many patients post-macula-off retinal detachment repair can have good visual acuity. Preliminary data suggest that patients with decreased visual acuity (less than 20/40) may have media opacities which are treatable as well as other potentially treatable macular abnormalities including: epiretinal membrane, cystoid macular edema, persistent subretinal fluid, or macular hole. Incomplete visual recovery due to retinal atrophy or IS/OS disturbance form a minority of patients.
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