Postoperative complications after successful primary rhegmatogenous retinal detachment repair

Abstract

Background To evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD). Methods Retrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD “pending foveal detachment” subgroup. Results Sixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6). Conclusions The risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.

The Role of the Intraoperative Optical Coherence Tomography for Vitreoretinal Surgery in a Real-Life Setting

“…It is debated whether the ILM should be peeled in RD surgery to avoid the secondary formation of ERM [ 21 ]. The i-OCT guided the surgeon in deciding when to avoid the ILM peeling in cases of significant thinning of the fovea ( Figure 13 ).…”

Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review

“…Postoperative epiretinal membrane formation, also known as macular pucker, is another reported complication affecting between 1.7% and 33.3% of patients [ 38 , 45 , 54 , 56 , 64 , 67 , 69 ]. In a study that examined the incidence of epiretinal membrane formation after successful primary RRD repair, postoperative epiretinal membranes developed in 15% and 28.5% of patients in the scleral buckling and PPV groups, respectively [ 113 ]. Similarly, a meta-analysis revealed that the incidence of epiretinal membrane formation was 7.1% and 5.2% in patients treated with PPV and scleral buckling alone, respectively [ 114 , 115 ].…”

Navigated yellow subthreshold micropulse laser for refractory cystoid macular edema following rhegmatogenous retinal detachment surgery

“…CME is a primary cause of reduced vision following both cataract and vitreoretinal surgery. 3 , 4 , 10 …”