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Andre J. Witkin, Jason Hsu, Marc Spirn, Sunir J. Garg, Richard S. Kaiser; Comparison of Pneumatic Retinopexy to Surgical Repair of Macula-off Rhegmatogenous Retinal Detachment Using Spectral Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2755.
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To compare spectral-domain optical coherence tomography (SD-OCT) findings and visual acuity outcomes after pneumatic retinopexy (PR), pars plana vitrectomy (PPV), scleral buckle (SB), and combination surgery (SB/PPV) for macula-off rhegmatogenous retinal detachment (RRD).
The study design was a retrospective observational case series. Patients with macula-off RRD present for less than 10 days and without proliferative vitreoretinopathy, previous retina surgery, recurrent retinal detachment during observation period, or other retinal comorbidities were included in the study. To repair the RRD, patients underwent PR, PPV, SB, or SB/PPV at the surgeon's discretion. Snellen vision was recorded and patients were imaged using SD-OCT at 1 and 3 months after RRD repair. Post-operative OCT measurements included central foveal thickness, foveal outer segment thickness, photoreceptor disruption, external limiting membrane disruption, and presence of subretinal fluid. Statistical analysis was performed using two-tailed t-tests, one-way ANOVA, and Pearson correlation.
Thirty patients met the inclusion criteria. Eight patients had pneumatic retinopexy, 6 patients had PPV, 10 patients had SB/PPV, and 6 patients had SB. One month after surgery, visual acuity was better in the pneumatic group versus the surgical groups (p = 0.08), but were equivalent among all groups after 3 months (p = 0.35). Persistent sub-retinal fluid after 2 months was present in 10 patients, 6 after PR, 2 after SB/PPV, and 2 after SB. Central foveal thickness (p = 0.94), foveal outer segment thickness (p = 0.51), and outer segment integrity (p = 0.76) did not differ significantly between groups. External limiting membrane integrity was greater after PR compared to surgical repair (p = 0.08). Foveal outer segment thickness (R = -0.56, p = 0.07) was a better predictor of postoperative visual acuity compared to central foveal thickness (R = 0.24, p = 0.46).
Patients had more rapid recovery of visual acuity after pneumatic retinopexy, however 3-month visual outcomes were equivalent. Delayed resorption of fluid was more common after pneumatic retinopexy. More patients had an intact external limiting membrane in the pneumatic retinopexy group, however other indicators of photoreceptor integrity were equivalent amongst all groups. Foveal photoreceptor outer segment thickness may be an indicator of visual acuity outcomes. A larger number of patients is needed to assess statistical significance of these results.
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