Macular edema after rhegmatogenous retinal detachment repair: risk factors, OCT analysis, and treatment responses

Abstract

Purpose To investigate risk factors, imaging characteristics, and treatment responses of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair. Methods Consecutive, retrospective case–control series of patients who underwent pars plana vitrectomy (PPV) and/or scleral buckling (SB) for RRD, with at least six months of follow-up. Clinical and surgical parameters of patients with and without CME (nCME), based on spectral-domain optical coherence tomography (OCT), were compared. Results Of 99 eyes enrolled, 25 had CME while 74 had nCME. Patients with CME underwent greater numbers of surgeries (P < 0.0001). After adjusting for number of surgeries, macula-off RRD (P = 0.06), proliferative vitreoretinopathy (PVR) (P = 0.09), surgical approach (PPV and/or SB, P = 0.21), and tamponade type (P = 0.10) were not statistically significant, although they all achieved significance on univariate analysis (P = 0.001 or less). Intraoperative retinectomy (P = 0.009) and postoperative pseudophakia or aphakia (P = 0.008) were more frequent in the CME group, even after adjustment. Characteristics of cCME on OCT included diffuse distribution, confluent cysts, and absence of subretinal fluid or intraretinal hyperreflective foci. Macular thickness improved significantly with intravitreal triamcinolone (P = 0.016), but not with anti-vascular endothelial growth factor agents (P = 0.828) or dexamethasone implant (P = 0.125). After adjusting for number of surgeries and macular detachment, final visual acuities remained significantly lower in the CME vs nCME group (P = 0.012). Conclusion Risk factors of CME include complex retinal detachment repairs requiring multiple surgeries, and pseudophakic or aphakic lens status. Although this cCME was associated with poor therapeutic response, corticosteroids were the most effective studied treatments.

Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes

“…CME diagnosis was defined as hyporeflective spaces regardless of the retinal layer involved. CRT was not considered for analysis because of the varying degree of macular atrophy [ 23 ]. SD-OCT characteristics were collected, such as the presence of ERM, central retinal thickness (CRT), outer retinal layer alterations (inner and outer segment junction (IS/OS) and/or external limiting membrane disruption), and localization of cysts in the inner retinal layers (IRL) or outer retinal layers (ORL).…”

“…The rate of CME after primary RRD repair ranges from 6% to 36%, regardless of the surgical technique used [ 8 , 9 , 20 , 21 , 22 ]. Age, lens status (pseudophakia and aphakia), macular status, and the severity of the retinal detachment, especially with proliferative vitreoretinopathy (PVR), are reported to be risk factors for CME after primary RRD repair [ 9 , 20 , 23 , 24 ]. Recently, Pole et al showed a relationship in univariate analysis between the number of surgeries, macular status, PVR grading, and the occurrence of CME, but these parameters were no longer significant in multivariate analysis [ 23 ].…”

“…Age, lens status (pseudophakia and aphakia), macular status, and the severity of the retinal detachment, especially with proliferative vitreoretinopathy (PVR), are reported to be risk factors for CME after primary RRD repair [ 9 , 20 , 23 , 24 ]. Recently, Pole et al showed a relationship in univariate analysis between the number of surgeries, macular status, PVR grading, and the occurrence of CME, but these parameters were no longer significant in multivariate analysis [ 23 ]. There are still limited data on the rate, risk factors, and outcomes of CME after RRD repair with PPV [ 24 , 25 ].…”

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes

“…The risk of CME secondary to RRD repair across included studies was unclear given the variable study design and surgical approach along with limited, nonspecific, and nonstandardized reporting of this complication between studies [45, 72]. Pre- and postoperative precautions such as the use of anti-inflammatory medications [66, 73], surgical techniques such as inner limiting membrane peeling [74, 75], and advancements in optical coherence tomography to monitor for developing CME [72] may aid in preventing, diagnosing, and managing CME following RRD repair. Furthermore, a lack of available data on CSFT at baseline and postoperatively made it difficult to calculate mean differences in retinal thickness over time.…”

“…Cystoid macular edema (CME) is well-reported following retinal detachment repair with SB and PPV with the incidence of CME post-PPV reported in 2.3-16.3% of cases [66][67][68] versus 6.9-43% with SB [68][69][70][71]. The risk of CME secondary to RRD repair across included studies was unclear given the variable study design and surgical approach along with limited, nonspecific, and nonstandardized reporting of this complication between studies [45,72]. Pre-and postoperative precautions such as the use of anti-inflammatory medications [66,73], surgical techniques such as inner limiting membrane peeling [74,75], and advancements in optical coherence tomography to monitor for developing CME [72] may aid in preventing, diagnosing, and managing CME following RRD repair.…”