Photoreceptor Disruption Related to Persistent Submacular Fluid after Successful Scleral Buckle Surgery

Abstract

PurposeTo investigate serial changes in photoreceptor status and associated visual outcome in patients with persistent submacular fluid after successful scleral buckle surgery for macula-off rhegmatogenous retinal detachment.MethodsThis was a prospective observational case series including 76 consecutive patients who underwent successful scleral buckle surgery for macula-off rhegmatogenous retinal detachment with symptom duration ≤90 days at a single tertiary hospital. Optical coherence tomography (OCT) and visual acuity examination were performed at one month and three months postoperatively and at three-month intervals until the submacular fluid disappeared. Main outcome measures were postoperative photoreceptor status on OCT and visual acuity.ResultsForty-two patients (55.3%) showed persistent submacular fluid at postoperative one month. Of 42 patients with persistent submacular fluid, three (7.1%) showed photoreceptor disruption on OCT. None of the 34 patients without persistent submacular fluid showed photoreceptor disruption. Two patients (4.8%) had progressive photoreceptor disruption, and one patient (2.4%) had early photoreceptor disruption. All three patients showed photoreceptor reappearance and limited visual restoration after absorption of submacular fluid. Final visual acuities were significantly worse in these three patients (20 / 1000, 20 / 133, and 20 / 133) compared to those of the other patients (mean, 20 / 30) with persistent submacular fluid and intact photoreceptors.ConclusionsEven after successful scleral buckle surgery for rhegmatogenous retinal detachment, photoreceptor disruption can occur related to persistent submacular fluid and may be a cause of poor visual outcome.

Multifocal Electroretinography and Spectral-Domain Optical Coherence Tomography in Macula-Off Rhegmatogenous Retinal Detachment

“…28 The effect of ELM disruption was highlighted in the present study by its relationship with higher IT values of the P1 response and was consistent with the fact that IT P1 is known to be a very sensitive measurement of outer retinal function. 19 Subretinal edema fluid was observed in 18% of eyes at M1 and for the most part resolved at M12 (3%), consistent with previously reported frequencies: from 10% to 81% of cases at M1 25,[29][30][31] resolved in 4% to 33% of the cases at 6 months. 17,27,30,31 The strengths of this study include its prospective design, the relatively high number of patients, the long duration of follow-up, and the use of an objective technique for visual function such as mfERG.…”

Multifactor analysis of delayed absorption of subretinal fluid after scleral buckling surgery

“…Chan et al found that images with high signal density in CSC were accompanied by the dilatation of large blood vessels, suggesting that the choroidal thickening in CSC may be due to the expansion of blood vessels [33]. Therefore, it was suggested [34,35] that the mechanism of SR after SB surgery may be similar to the pathogenesis of CSC, such as choroidal hypertonicity and choroidal thickening. The results of our study show a moderate positive correlation between SRFH and SFCT at the macular fovea (r s = 0.462, P = 0.000).…”

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

“…In a few cases, intravitreal triamcinolone was also tried 7. One school of thought advocates for early management since SRF can cause permanent damage to photoreceptors if left untreated 10–12. In contrast, a recent study8 found no significant difference in patients’ visual recovery with or without surgical intervention.…”