Long-term Post-operative perfusion outcomes in giant retinal tears treated with and without scleral buckling

Abstract

Limited data are available on the long-term perfusional status of patients who have undergone successful surgery for giant retinal tear (GRT) macula-off rhegmatogenous retinal detachment (RRD). This study examines the long-term outcomes in eyes treated for varying degrees of GRT-associated RRD extensions and compared them with two control groups. Twenty-five emmetropic normal eyes (control emmetropic), 20 healthy myopic eyes (control myopic), and 33 eyes surgically treated for GRT (surgical) were included in this study for a comparison of long-term structural, perfusional, and functional outcomes. The surgical eyes were categorized based on degree of GRT-associated RRD extension: 19 eyes with GRT-associated RRD extension <180° and 14 eyes with extension >180°. The eyes were further separated by whether they required placement of a complementary 360° scleral buckle. The mean age of the patients was 55.18 years and the mean pre-operative evolution of GRT was 2.36 weeks. The average pre- and post-operative best-corrected visual acuities (BCVAs) were 1.90 logMAR and 0.59 logMAR, respectively, which were different with statistical significance. Proliferative vitreoretinopathy resulted in multiple surgeries in nine eyes (27.3%). Long-term post-operative optical coherence tomography (OCT) showed 11 eyes (33.3%) with abnormal foveal contour, 13 eyes (39.4%) with ellipsoid zone disruption, two eyes with dissociated optic nerve fiber layer defects, and 15 eyes (45.4%) with external limiting membrane line discontinuities. OCT angiography yielded abnormal perfusion indices in the surgically treated eyes (P < 0.0001). Correlation analysis found that post-surgical BCVA was negatively correlated with superficial foveal avascular zone area, superficial parafoveal vessel density, and central subfoveal thickness, while positively correlated with choriocapillaris flow area. Our data showed that eyes with GRT-associated RRD have multiple structural alterations in spectral-domain OCT biomarkers that are correlated with visual outcomes. Despite successful retina reattachment without proliferation, management of GRT-associated RRD remains challenging.

Postoperative Choroidal Vascular Biomarkers in Eyes with Rhegmatogenous Retinal Detachment-Related Giant Retinal Tears

“…In this study, patients’ medical records, which were retrospectively studied to compare the retinal and choroidal perfusion, vessel densities, and structural outcomes of interventions in RRD-related GRT cases, were reviewed to collect postoperative CVI, CFA, and CSFT values in the surgical group. This was the same group of patients previously published [ 31 ]. The same values for the contralateral (fellow) eyes were used as the control group.…”

“…f The choriocapillaris binarized image depicts a normal postoperative CFA of 2.113 mm 2 in a selected subfoveal flow area of 3.142 mm 2 . This modified figure was adapted from [ 31 ] and used under Creative Commons Attribution 4.0, International License ( https://creativecommons.org/licenses/by/4.0/ )

Fig. 5 Surgical case 2.

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“…The surgical techniques used to treat these patients have been previously described [ 31 , 34 ]. Conventional 25-gauge three-port pars plana vitrectomy (PPV) techniques were used.…”

“…CVI is the percentage of vascular luminal area (LA) within the preselected total choroidal area (TCA) [ 30 ]. A recent study reported a decrease in retinal and choroidal perfusion after PPV with or without SB, which was more significant in eyes with SB [ 31 ]. In addition, SB has been associated with a decrease in retinal arterial blood flow rate [ 32 ], but its effects on CVI and CFA have not been previously established [ 33 ].…”