Early Structural and Vascular Changes after Within-24 Hours Vitrectomy for Recent Onset Rhegmatogenous Retinal Detachment Treatment: A Pilot Study Comparing Bisected Macula and Not Bisected Macula

Abstract

Background: In this study we aimed at investigating macular perfusion/anatomical changes in eyes with early onset rhegmatogenous retinal detachment (RRD) after prompt surgery within 24 hours, comparing a bisected macula and not bisected macula RRD. Methods: In this prospective observational study, 14 eyes of 14 patients who underwent within-24 hours vitreoretinal surgery for early onset RRD were enrolled. Patients were further divided into two subgroups: the not bisected macula group (NBM group) and the bisected macula group (BM group). At baseline and 3-month follow up, macular architecture and vessel analysis were assessed using optical coherence tomography angiography (OCTA) imaging. In detail, quantitative and qualitative analyses of the macular area were performed to quantify topographical retinal perfusion changes after surgery, calculating the foveal avascular zone (FAZ), vessel density (VD) and vessel length density (VLD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results: Most cases (43%) were superotemporal RRD. Primary retinal reattachment was obtained in all cases, without recurrences within 3-month follow up. After surgery, a significant FAZ enlargement was observed at both the SCP and DCP level (p < 0.001; p < 0.05), with a significant effect of time noted between the two time points in the NBM and BM subanalysis (F = 3.68; p < 0.017). An excellent functional outcome was maintained for the whole follow-up. On the other hand, after surgery, perfusion parameters did not change significantly apart from the vessel density of the inferior macular sector at the DCP level (p = 0.03). Conclusions: Our findings suggest that the macular perfusion of eyes with RRD is still preserved if the surgery is performed really promptly, thus highlighting the great importance of a correct timing for surgery. OCTA analysis allows for a better understanding of the pathophysiological mechanisms underneath early vascular microarchitecture modifications of the posterior pole in retinal detachment, differentiating the two types of RRD not completely involving the fovea (BM and NBM).

Macular microcirculation changes after repair of rhegmatogenous retinal detachment assessed with optical coherence tomography angiography: A systematic review and meta-analysis

“…Twelve studies including 430 RRD eyes and 430 control eyes were selected in this study ( Agarwal et al, 2019 ; Woo et al, 2018 ; McKay et al, 2020 ; Ng et al, 2020 ; Wang et al, 2019 ; Hong et al, 2020 ; Bonfiglio et al, 2020 ; Barca et al, 2020 ; Christou et al, 2021 ; Liu et al, 2021 ; D'Aloisio et al, 2022 ; Chatziralli et al, 2022 ), as indicated in Table 1 . The search strategy for Pubmed is showed in Supplementary Table S1 .…”

“…As showed in Table 1 , two studies selected macular-on RRD, six studies collected macula-off RRD, and the remaining four studies included both macula-on and macula-off RRD. In the study by D'Aloisio et al, part of the macula was detached before surgery in 6 RRD patients who received treatment within 24 h of onset ( D'Aloisio et al, 2022 ). This group of eyes was considered as macular-on RRD for analysis in our study.…”

Long-Term Macular Vascular Changes after Primary Rhegmatogenous Retinal Detachment Surgery Resolved with Different Tamponade or Different Surgical Techniques

“…A fair number of studies with a follow-up no longer than 8 months were investigated. Reduction of VD in retinal capillary plexuses in comparison to fellow eyes at post-operative follow-up was usually reported in literature, with more significant evidence in Macula-OFF condition [ 11 , 21 , 22 , 23 , 24 , 25 ]. In contrast, Hong et al found that the SCP and DCP VD in the operated eyes did not differ significantly from the fellow eyes for both the Macula-ON and Macula-OFF groups, at 6 months follow-up [ 26 ].…”

Retinal Microvascular Alterations in Hidradenitis Suppurativa Patients: A Pilot Study Using Optical Coherence Tomography Angiography

“…Diabetic retinopathy (DR) is associated with systemic vascular complications likely reflecting widespread microvascular disease, and OCTA has become the tool of choice for the early detection of DR and other retinal vascular diseases [ 15 , 20 , 21 , 22 , 23 , 24 ]. Recent studies have demonstrated that retinal vessel density and retinal perfusion reflect systemic inflammatory responses [ 22 , 25 , 26 ] and that retinal and choroidal thickness may serve as potential biomarkers of systemic inflammation [ 27 , 28 ].…”