The Clinical Features of Macular Pucker Formation after Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

Abstract

PurposeTo investigate the incidence and predisposing factors of macular pucker formation after pars plana vitrectomy in patients who developed primary rhegmatogenous retinal detachment.MethodsWe retrospectively reviewed a consecutive series of 284 eyes in 284 patients who underwent primary retinal detachment repair by pars plana vitrectomy alone between January 1, 2009 and December 31, 2010. Patients with a history of retinal surgery or another visually significant ocular problem were excluded.ResultsPostoperatively, of the 264 eyes that completed at least six months of follow-up, 16 (6.1%) eyes developed obvious macular pucker at clinical examination. Of these 16 eyes, ten (70.0%) underwent repeat vitrectomy with membrane peeling for macular pucker removal during the follow-up period. The mean time from primary vitrectomy for the retinal reattachment to the secondary vitrectomy with membrane peeling for macular pucker was 7.9 months. The mean improvement in vision after membrane peeling surgery was 0.37 (logarithm of the minimum angle of resolution). Using an independent t-test, chi-square test, and Mann-Whitney U-test, we found that the number or size of retinal break and vitreous hemorrhage could be significant risk factors of macular pucker.ConclusionsIn our study, 6.1% of eyes which underwent pars plana vitrectomy alone for primary retinal detachment developed a postoperative macular epiretinal membrane. Multiple or large retinal breaks and postoperative vitreous hemorrhage were related to macular pucker formation. Overall, the 70.0% of eyes which underwent secondary vitrectomy with membrane peeling for removal of macular pucker showed a favorable visual outcome.

Macular optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment

“…Although ERM may also occur after ab externo techniques of vitreoretinal surgery, as scleral buckling, its incidence is higher in eyes treated with pars plana vitrectomy, with an estimated prevalence of 6%-35%. 62 ERM formation may limit visual recovery as its contraction causes significant retinal distortion. Second surgery for membrane peeling is occasionally required, with increased morbidity and costs.…”

Effects of internal limiting membrane peeling during vitrectomy for macula-off primary rhegmatogenous retinal detachment

“…7,8 Furthermore, satisfactory anatomical and functional outcomes have been demonstrated after ILM peeling during surgery for myopic macular hole, 9,10 in cases for which macular hole has formed secondary to trauma, 11,12 and in cases of macular hole that coexists with primary rhegmatogenous retinal detachment (PRRD). 13 ERM is one of the most common postoperative complications of surgery for PRRD, with an incidence of 3%-8.5% when only the episcleral buckling procedure is used and 6.1%-12% [14][15][16][17][18][19] when vitrectomy is performed. Previous studies have suggested that ILM peeling can prevent ERM development after vitrectomy for retinal detachment (RD) complicated by silicone oil endotamponade 20 or proliferative vitreoretinopathy (PVR) 21 and, more recently, after surgery for PRRD.…”

Combined Cataract Extraction and Vitrectomy for Macula-sparing Retinal Detachment: Visual Outcomes and Complications

“…However, ERMs have not been associated with cataract extraction [ 24 ]. Previous studies have reported an incidence of 6.1% to 20.5% following surgery for rhegmatogenous retinal detachment [ 25 , 26 ]. In the present study, six patients (10.7%) who developed ERM presented with multiple and larger breaks compared to others, which is similar to previous results reporting a high incidence of ERMs in relation to the number and size of the retinal break [ 25 ].…”

“…Previous studies have reported an incidence of 6.1% to 20.5% following surgery for rhegmatogenous retinal detachment [ 25 , 26 ]. In the present study, six patients (10.7%) who developed ERM presented with multiple and larger breaks compared to others, which is similar to previous results reporting a high incidence of ERMs in relation to the number and size of the retinal break [ 25 ]. Also, ERMs are diagnosed based on findings of spectral domain OCT, which make the diagnosis more precise and accurate and increase the detection rate of ERMs.…”