Abstract
Purpose :
To evaluate visual outcomes in eyes with macula-off retinal detachments (RD) with purposeful submacular fluid retention after vitrectomy to allow for slow pneumatic macular flattening.
Methods :
Retrospective study of 139 patients with macula-off RD. Patients were included if repaired with primary vitrectomy (VIT) or VIT with scleral buckle (SB). Patients were excluded if they had >6 wks to surgery, prior vitreous surgery, SB alone, drainage retinotomy or perfluorocarbon, development of proliferative vitreoretinopathy (PVR), <6 mon follow up, or other macular pathology. Patients underwent 3-port pars plana VIT with SB. Subretinal fluid was aspirated from pre-existing retinal breaks during air-fluid exchange (AFX). At the end of surgery fluid remained in the posterior pole and SF6 or C3F8 gas was then introduced with proper head positionoing.
Results :
Subretinal fluid was reabsorbed and gas fill was observed at post-op day 1. Mean baseline vision was 20.0±24.4 ETDRS letters (20/400) for 127/198 included patients. Of 71 excluded patients, 12 developed PVR. Primary repair success rate was 91.4% (127/139). Mean time to surgery was 8.6±7.9 days. At 6 months post-op, mean vision improved to 62.9±17.9 letters (20/60), an increase of 43.1±28.0 letters (8.6 lines) which was better than baseline (p<0.001). Best achieved vision averaged 72.6±13.2 letters (20/30-2), an increase of 52.8±25.1 letters (9.5 lines), at an average of 14.1±11.0 months later (p<0.001 vs baseline & 6 months post-op). Mean time to final follow-up was 25.8±26.5 months. Patients with ≥20/40 vision increased from 3.1% at baseline to 44.9% at 6 months post-op to 74.8% at best achieved vision. Conversely, patients with ≤20/200 vision decreased from 78.7% at baseline to 14.2% at 6 months post-op to 4.7% at best achieved vision.
Conclusions :
Good visual outcomes may be achieved and maintained even if the duration of the macular detachment is longer than several weeks. Leaving fluid in the macula at the end of the surgery may allow the RPE pump to more physiologically remove submacular fluid, and for the photoreceptor/RPE microvilli interdigitation to anneal with better retinotopic organization, promoting visual recovery.
This is a 2021 ARVO Annual Meeting abstract.