Persistent subfoveolar fluid following retinal detachment surgery: an SD-OCT guided study on the incidence, aetiological associations, and natural history

Abstract

Purpose To investigate the incidence and natural history of persistent subfoveolar fluid (PSF) following surgery for macular off rhegmatogenous retinal detachment and the effect of PSF on photoreceptor structure and final visual acuity. Methods Retrospective study of 61 cases with post-operative optical coherence tomography (OCT) performed within 12 weeks of surgery. Based on aetiology, cases were categorized into tractional retinal tears (TRT) group or atrophic round holes and dialyses (RHD) group to investigate the incidence and duration of PSF. A Kaplan-Meier graph was plotted to compare survival time of subfoveolar fluid for both groups. Following secondary reclassification of cases into those with and without PSF, the effect of PSF on final visual acuity and photoreceptor structure was investigated with Mann-Whitney U-test used for comparison. Spearman's correlation testing was used to probe associations between time to recorded resolution of PSF with final visual acuity and photoreceptor structure. Results Incidence of PSF was greater in the RHD group and persisted for longer compared with TRT group. No detectable adverse effect of PSF on final visual acuity was seen however an individual case of severe photoreceptor atrophy was observed. No significant correlation was found between the time to recorded resolution of PSF and the final visual acuity or to photoreceptor grading scores. Conclusions A difference in incidence of PSF was detected between the aetiological groups. PSF was ubiquitous and slow to resolve in the RHD group. Most cases of PSF resolve without adverse sequelae; however, progressive photoreceptor atrophy and sub-optimal visual outcome may result in a minority.

Influence of submacular fluid on recovery of retinal function and structure after successful rhegmatogenous retinal reattachment

“…In eyes with atrophic round retinal hole(s), a smaller volume of vitreous humor would tend to flow into the subretinal space because the age-related liquefaction of the vitreous body had not progressed. This will result in a slower progression of the detachment, and should lead to RRD eyes with atrophic round retinal hole(s) to have a systematic chronicity and the fluid current induced differences in the viscosity, protein, and cellular content of the subretinal fluid [29]. This would explain our observation of a higher incidence of SMF in the macula-off RRD treated by SB surgery.…”

An optical coherence tomography study of residual subfoveal fluid after successful pars plana vitrectomy in patients with diabetic tractional macular detachment

“…OCT imaging of the macular area can provide considerable help in explaining the mechanisms behind delayed functional recovery. Persistent «blebs», or «clefts» of SRF can be seen after macroscopically successful surgery for retinal detachment, including scleral buckling surgery [16]. The incidence of residual submacular fluid on the first postoperative OCT scan (4-6 weeks after surgery) for rhegmatogenous retinal detachment, according to various authors, varies from 15 to 90% [13,[16][17][18].…”

“…It has been suggested that the fluid may be of exudative origin or represent choroidal leakage [17,23]. However, most authors have concluded that the chronic course of detachment is a predisposing factor that leads to changes in viscosity, protein composition and cellularity of the SRF, which slows fluid absorption [16,24]. Tee et al [16], in comparing SRF absorption rates after RD surgery in patients with atrophic and tractional tears, discovered that chronic detachments associated with atrophic tears required a three times greater period for SRF resorption when compared with acute detachments associated with tractional tears [16].…”

“…The introduction of optical coherence tomography (OCT) into clinical practice has contributed significantly to revealing subtle changes in the macular structure after vitrectomy for various retinal pathologies [11][12][13][14][15]. Many studies have addressed issues of persistent submacular fluid after vitrectomy for rhegmatogenous retinal detachment detectable by OCT examination [16][17][18][19][20]. Recently, three clinical cases of delayed, gradual recovery of central vision associated with slow resolution of the subfoveolar fluid after vitrectomy for diabetic tractional macular detachment were described [21].…”

Internal Limiting Membrane Peeling for Persistent Submacular Fluid after Successful Repair of Diabetic Tractional Retinal Detachment

“…It means that delayed residual subfoveal fluid resorption is a common phenomenon in clinically successful surgery. Although most cases resolve with observation, long-standing submacular fluid can damage photoreceptors, cause permanent visual loss, trigger retinal thinning, and possibly contribute to macular hole formation [7, 8].…”