Clinical Analysis of Persistent Subretinal Fluid after Pars Plana Vitrectomy in Macula with Diabetic Tractional Retinal Detachment

Abstract

(1) Background: We analyzed the duration of persistent subretinal fluid (PSF) and the contributing factors of PSF after pars plana vitrectomy in patients who had a macula with diabetic tractional retinal detachment (TRD). (2) Methods: Forty eyes of 40 patients who had pars plana vitrectomy due to a macula with diabetic TRD, between 2014 and 2020, were retrospectively reviewed. The duration of PSF, as well as relevant ocular and systemic factors, was analyzed. (3) Results: The mean duration of PSF was 4.4 ± 4.7 months. The prevalence of PSF was 75.0% at 1 month, 50.0% at 3 months, 30.0% at 6 months and 10.0% at 12 months after surgery. Blood urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR) were significantly associated with the duration of PSF in the univariate analysis. In the multivariate analysis, only eGFR was significantly associated with the duration of PSF (β = −0.089, p = 0.030). (4) Conclusion: PSF may persist for more than 12 months in a macula with diabetic TRD after vitrectomy. Moreover, patients with impaired kidney function tended to have a delayed subretinal fluid absorption. Therefore, careful investigation of preoperative systemic conditions, especially kidney function, should be considered before TRD surgery in diabetic patients.

Spontaneous resolution of subretinal fluid postvitreoretinal surgery for tractional retinal detachment in proliferative diabetic retinopathy

“…It is worth to be noticed that only a few cases have been reported in macula-threatening TRD 7. Most cases are reported in macula-off TRD 5 7–9. Our case report described the persistence of SRF in the eye with macula-threatening TRD.…”

“…Of the many factors listed, only deranged renal function tests were significantly associated. It was hypothesised that impaired kidney functions, could be related to slow absorption of fluid leading to the persistence of SRF 9. In our case, the patient had early kidney failure, leading to moderate proteinuria.…”

“…No postoperative SRF was noticed in the fellow eye, after diabetic vitrectomy. As opposed to earlier beliefs, delayed SRF resorption is quite common after clinically successful diabetic vitrectomy for macula-off TRD, with a prevalence of 100% at 1 month which decreases to 25% at 9 months 8 9. Though in many cases, macroscopic SRF is not present, it is noticed only after OCT examination 5.…”

“…Various researchers have attempted to assess the risk factors for causing SRF persistence, but no consensus has been achieved 5 7–9. Persistence of SRF can be due to chronic detachment or exudation due to surgical manipulation or in response to endolaser 5.…”

“…Karimov et al 7 has attributed non-drainage of SRF as a substantial risk factor for long-term SRF. Kang and Shin9 have evaluated multiple factors in the persistence of SRF. Of the many factors listed, only deranged renal function tests were significantly associated.…”