Structural and Functional Macular Changes After Retinectomy for Retinal Detachment Complicated by Proliferative Vitreoretinopathy

Abstract

Purpose: To report anatomical and functional outcomes of nonprimary retinectomy for rhegmatogenous retinal detachment with Grade C proliferative vitreoretinopathy, to assess the structural and functional macular changes in successful eyes.Methods: Retrospective single-center cohort study: one hundred-one consecutive retinectomies of 101 eyes affected by rhegmatogenous retinal detachment with C proliferative vitreoretinopathy between January 2014 and February 2020 were included.Results: The mean preoperative best-corrected visual acuity (BCVA) was 1.48 ± 0.71 logarithm of the minimal angle of resolution (20/604 Snellen equivalent). The anatomical success rate was 78.2% after one retinectomy and 83.1% after two retinectomies. The final BCVA $ 20/200 was achieved in 29% of cases, 8% gained $ 20/80. The final mean postoperative BCVA of successes with oil in situ was 1.68 ± 0.59 (20/957 Snellen equivalent) compared with 1.07 ± 0.63 logarithm of the minimal angle of resolution (20/235 Snellen equivalent) of successes after oil removal (P = 0.00005). Postoperative macular optical coherence tomography was obtained from 60/84 successes (71%). The normal macular profile was found in 3%, whereas majority demonstrated exudative maculopathy (51.5%), macular atrophy (22%), tractional maculopathy (21.5%), and macular disciform scar (2%). Bivariate linear relationship between final central foveal thickness and BCVA was statistically significant (P = 0.000013).Conclusion: Satisfactory anatomical and functional outcome is possible after retinectomy for C proliferative vitreoretinopathy. Positive prognostic factors include the removal of oil without redetachment, normal macular status, and lower central foveal thickness. The functional outcome was influenced by macular changes, as final BCVA and central foveal thickness correlated.

Reply

“…The redetachment rate after SOR in eyes diagnosed with preoperative PVR was 20% (8 of 40 eyes), which is within the range reported in the literature. 2,3 We found no difference in redetachment rate compared with eyes without preoperative PVR (OR 1.50 (0.66–3.39, P = 0.3315). 1 Most of the eyes included in this study exhibit complex pathology including macula-off status, RRD size > 2 quadrants, history of previous surgeries, and history of retinectomy during initial RRD repair.…”

Nontraumatic bilateral inferior ectopia lentis

“…Pars plana vitrectomy is an established treatment for eyes with rhegmatogenous retinal detachment (including challenging cases complicated by proliferative vitreoretinopathy) and with vitreoretinal interface syndrome and with aqueous misdirection. [ 3 4 5 6 ] but less so for different conditions. [ 7 8 9 10 ] Anterior iris–claw or retropupillary iris–claw IOL implant after vitreolensectomy has been suggested in EL eyes without capsular support;[ 11 12 ] decrease in the average endothelial cells density and cystoid macular edema are the main long-term complications described.…”

Early vitrectomy in eyes with non-diabetic vitreous hemorrhage

“…9 Treatment is then undertaken once the view becomes clear enough to make a diagnosis (such as in the case of RVO or RT). PPV is an established treatment for eyes with RRD (including challenging cases complicated by PVR), with vitreoretinal interface syndrome and with aqueous misdirection, [10][11][12] but less so for NDVHs. [13][14][15] Surgical intervention is reserved for patients where RT or RRD is diagnosed on B-scan ultrasonography.…”