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D.G. Charteris, S. Benson, P. Schlottman, C. Bunce; Optical Coherence Tomography Analysis of the Macula After Scleral Buckling and Vitrectomy Surgery for Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5482.
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Purpose: To determine the morphology of the macula and its relationship to functional outcome in patients undergoing scleral buckling or vitrectomy surgery for rhegmatogenous retinal detachment (RD) Methods: Serial optical coherence tomography (OCT) analysis of the maculae of 75 consecutive patients undergoing scleral buckling surgery (43 macula attached) and 87 consecutive patients undergoing vitrectomy (43 macula attached) as primary surgery for RD using the Zeiss 3000 OCT scanner. Primary outcome measure – presence and pattern of persistent subretinal fluid (SRF). Secondary outcome measures – duration of SRF, and association of SRF with visual outcome, clinical features of RD and type of surgery. Results: Three patterns of residual SRF were identified – single blebs, multiple blebs and confluent SRF. In the scleral buckle group 40 of 75 (53%) had residual fluid at 1.5 months, of these 10 had a single bleb, 11 had multiple blebs and 19 had confluent SRF. In the vitrectomy group 14 of 87 (16%) had residual fluid at 1.5 months – 11 had single blebs and 3 confluent fluid. The difference in incidence was significant (P<0.01). Patients with residual SRF had significantly worse visual acuity (P=0.014). Longer RD duration was associated with higher incidence of SRF (P=0.03). Both macula attached and detached patients had residual fluid after both buckling and vitrectomy surgery, fluid being less common in when the macula was not involved (P<0.001). 10 of 54 patients with residual SRF (all of whom had scleral buckling surgery) had resorption of fluid after a mean of 9.5 months (range 4–17), this tended to be associated with improved visual acuity. Conclusions: Localised residual SRF, undetected clinically, is common after successful RD repair. Such fluid may slowly reabsorb with an associated visual improvement. OCT is a useful technique for the assessment of macular anatomy following retinal surgery.
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