Incidence and risk factors for macular oedema after primary rhegmatogenous retinal detachment surgery: a prospective single‐centre study

Abstract

Purpose To assess the incidence of cystoid macular oedema (CME) diagnosed by spectral domain optical coherence tomography (SD‐OCT) after primary rhegmatogenous retinal detachment (RRD) surgery. Methods From April 2016 to October 2017, 150 eyes of 150 patients presenting with primary RRD were included consecutively in this prospective single‐centre study. Patients with the following characteristics were excluded: previous vitreoretinal surgery, combined cataract surgery, preoperatively presentation with any intraocular or systemic inflammatory condition, visible macular oedema or epiretinal membrane (ERM) on funduscopy. SD‐OCT (Spectralis, Heidelberg Engineering) was conducted 3 and 6 weeks after surgery. Results One hundred and twenty‐eight of the 150 patients completed the study, of whom 107 (age: 61.7 ± 11.5 years, mean ± SD) showed successful retinal attachment during follow‐up visits. The most frequent operation method was scleral buckling (54.2%), followed by vitrectomy (25.2%) and the combination of both techniques (20.6%). Postoperative SD‐OCT revealed CME, neurosensory detachment and ERM in 18.7, 31.8 and 32.7% of all cases, respectively. The risk of postoperative CME was significantly elevated in patients with ERM (42.9 versus 6.9%, p < 0.001). In addition, patients with initial detachment of the macula had more postoperative CME (26.5 versus 11.1%, p = 0.044). BCVA improvement was significantly lower in patients with CME compared to patients without 6 weeks after surgery for macula‐on RRD. Conclusions This prospective study confirmed that postoperative CME is a frequent complication after RRD surgery; we identified ERM and macula‐off RRD as potential risk factors. As CME potentially delays visual recovery, postoperative follow‐ups should include SD‐OCT.

Comparison Between Scleral Buckling and Vitrectomy in the Onset of Cystoid Macular Edema and Epiretinal Membrane After Rhegmatogenous Retinal Detachment Repair

“…Our results differ from those of some recent reports in this setting. Specifically, in a 6-week prospective study, Gebler et al 4 reported a CME rate of 16.3% for the PPV and 20.7% for the SB patients and found no differences between the procedures. 4 Overall, considering the short follow-up, the rate of CME in this study is higher than in our findings, especially in the SB cases.…”

“…Specifically, in a 6-week prospective study, Gebler et al 4 reported a CME rate of 16.3% for the PPV and 20.7% for the SB patients and found no differences between the procedures. 4 Overall, considering the short follow-up, the rate of CME in this study is higher than in our findings, especially in the SB cases. This discrepancy could be attributed to the extensive use of gas tamponade, injected in 65.5% of their SB procedures, as an adjunctive tool to achieve retinal reattachment.…”

“…[1][2][3] The incidence of CME after RRD surgery is reported to be ranging from 3% to 43%, showing great variability among different studies. [4][5][6] The development of ERM after RRD repair has been assessed by previous authors with reported rates ranging from 3% to 70%. [7][8][9] Furthermore, in the literature, only a few studies have compared the incidence of these adverse events between SB and PPV.…”

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

“…Fig. S1) [16,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. Eight (44.44%) studies explicitly excluded and/or did not have any baseline eyes with PVR grade C or worse, nine (50%) excluded eyes with a history of ocular trauma, seven (38.89%) excluded eyes with macular hole, and nine (50%) excluded eyes with previous vitreoretinal surgery.…”

“…In the main analysis, the removal of one study at a time resulted in final BCVA being significantly better with SB alone [32] and a higher incidence of IOP elevation with SB + PPV with the cited references removed from analysis [41]. Final reattachment rate [39,43] as well as the incidence of macular edema [29,41,45,48] and cataract development or progression were no longer significantly different between SB + PPV and SB alone upon individual removal of the cited references from analysis [40][41][42][43].…”