Assessment of Vascular Changes in Patients after Pars Plana Vitrectomy Surgery Due to Macula-Off Rhegmatogenous Retinal Detachment

Abstract

The aim of this study was to investigate the changes in the retinal capillary plexuses in patients after pars plana vitrectomy (PPV), which is used for the treatment of rhegmatogenous retinal detachment (RRD). In this study, we included the results of 114 patients who underwent PPV after total retinal detachment (RRD; retinal detachment group). It should be kept in mind that to qualify for the study group, there was a condition that retinal detachment be only present in one eye, allowing the fellow healthy eye to be used for the control group, and the study, therefore, did not include cases where retinal detachment occurred binocularly. Optical coherence tomography (OCT) and OCT-A images were taken at 9 ± 2 months (median 10 months) after the surgery, with the study conducted in the years 2017–2019. OCT was used to examine the external limiting membrane (ELM), central macular thickness (CMT) and retinal nerve fiber layer (RNFL), while OCT-angiography (OCT-A) was used to examine the extent of the foveal avascular zone (FAZ) in the deep and superficial capillary plexuses. Changes in the FAZ area of the superficial plexus (SCP) between the study and control groups were analyzed over 346 ± 50 days. In our study, we observed changes in the FAZ area between the RRD and control groups in the SCP (203.65 ± 31.69 μm2 vs. 215.30 ± 35.82 μm2; p = 0.28733) and DCP (284.79 ± 35.82 µm2 vs. 336.84 ± 32.23 µm2; p = 0.00924). Changes in the RNFL thickness between the study and control groups over 346 ± 50 days were as follows: 90.15 μm vs. 82.44 μm; p = 0.19773. Disruption of the external limiting membrane was observed in 78.95% (90 eyes) of the study group. In the control group, it was undamaged, and no integrity disorder was observed. In the RRD, changes occurred in the FAZ of both the SCP and the DCP, which reduced the extent of this zone, an effect that was more pronounced in DCPs. A better understanding of the anatomical and hemodynamic changes taking place in the retina after macula-off RRD might be helpful in answering the question as to why BCVA in these cases is “only” or “as much as” from 0.4 to 0.1, namely, that it might be related to changes in the neurosensory retina after macular peeling.

Microvascular changes after pars plana vitrectomy for rhegmatogenous retinal detachment repair: A comparative study based on gas tamponade agent

“…16,17 Until now, only Boron et al have mentioned a statistically significant decrease of FAZ in DCP. 21 In our study, we also noted a change of the FAZ perimeter, which, to our knowledge, has not been investigated before. More specifically, the FAZ perimeter was found to be increased in the DCP.…”

Optical Coherence Tomography Angiography Morphology After Rhegmatogenous Retinal Detachment Repair

“…However, the studies that were largely focused on FAZ area had conflicting results. Woo et al 27 demonstrated FAZ enlargement after successful PPV while Lyssek-Boroń et al 22 demonstrated a reduction in the FAZ area postoperatively. Bonfiglio et al 28 demonstrated no significant change in the FAZ area post-PPV.…”

“…The use of FAZ area as a biomarker for retinal diseases has been extensively studied in the literature. [21][22][23] However, measurements of even normal FAZ size can have large intersubject variability that correlates with a patient's age, sex, axial length, refractive error, and central macular thickness. 24 Foveal avascular zone geometry has been demonstrated to display good reproducibility and repeatability in normal subjects, possibly being a more reliable tool to detect vascular alterations when evaluating the SCP.…”

Differences in Vascular Density between Detached and Nondetached Areas in Eyes with Rhegmatogenous Retinal Detachment

“…OCTA is a novel noninvasive method to visualize and provide quantitative vascular information on macular microcirculation, including the retinal capillary plexus and CCP with good repeatability and reproducibility [ 11 , 12 , 13 , 14 ]. Studies have reported that the VD in the SCP, DCP, and CCP decreased significantly compared with the fellow eyes or macula-off eyes [ 12 , 15 , 22 ]. However, a comparison in different OCTA images may affect the results [ 23 , 24 ].…”