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Julia Kuhn, Joseph Martel; Predictive Value of Perioperative Circumpapillary Retinal Nerve Fiber Layer Thickness in Primary Rhegmatogenous Retinal Detachment Macular Anatomic Outcomes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3885.
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© ARVO (1962-2015); The Authors (2016-present)
Despite successful rhegmatogenous retinal detachment (RRD) surgery, postoperative macular edema, epiretinal membrane (ERM) formation, and macular atrophy are difficult to predict, yet important factors influencing final visual outcome. We performed a retrospective observational clinical study to examine the perioperative spectral domain optical coherence tomography (sdOCT) circumpapillary retinal nerve fiber layer (cpRNFL) thickness as a predictor for the development of postoperative macular disease in patients undergoing successful RRD repair surgery.
A review of longitudinal data from 2009 - 2014 at the University of Pittsburgh Medical Center identified 36 patients having undergone successful primary RRD surgery without previous posterior segment surgery, optic nerve disease, or macular disease, and availability of preoperative and postoperative cpRNFL and macular sdOCT imaging data. The nonoperative contralateral eye was used for all group comparisons as a control. Statistical analyses were performed using a two-tailed Student’s t test and Wilcoxon rank-sum test.
Of 36 patients who met inclusion criteria, 28 underwent RRD repair with vitrectomy and 8 with scleral buckling. Median follow-up time was 12 months (range 0.5-55 months), and mean follow-up visits was 2.0 (range 1-10). Mean cpRNFL was 91.97µm ±14.73 in RRD eyes and 85.48µm ±12.09 in control eyes (p<0.0001). Mean macular central subfield thickness (CST) was 325.51µm ±76.19 and 293.30µm ±59.21 in RRD and control eyes, respectively (p=0.0076). For RRD patients who developed late postoperative central macular edema (CST >300µm), median cpRNFL thickness in the early postoperative period was significantly greater than for RRD patients who did not develop late postoperative central macular edema (p=0.0027). In RRD patients who developed late central subfield macular thinning (CST<250µm), median cpRNFL thickness was not found to be significantly less than in those patients who did not develop macular thinning (p=0.9552).
Early perioperative cpRNFL thickening may be a predictor for late postoperative macular edema in patients undergoing successful RRD repair surgery. Relative cpRNFL thinning or thickening was not predictive of central macular thinning.
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