Vascular changes after vitrectomy for rhegmatogenous retinal detachment: optical coherence tomography angiography study

Abstract

To analyse the postoperative foveal avascular zone (FAZ) area, superficial vessel density (SVD) and deep vessel density (DVD) and their correlation with functional (best-corrected visual acuity, BCVA) and anatomical outcomes (foveal macular thickness, FMT) after surgery for rhegmatogenous retinal detachment (RRD) repair. Method: Patients with RRD eyes, successfully treated with a single pars plana vitrectomy (PPV) with gas tamponade and a minimum 12 months follow-up, were re-examined. Foveal avascular zone (FAZ) area, SVD, DVD and FMT were evaluated by using optical coherence tomography angiography (OCTA) and compared to fellow eye. Results: Fifty-six patients with macula-on and 37 with macula-off RRD were included in the study. In both groups, no difference in FMT and FAZ area was found compared to fellow eyes. In macula-on RRD eyes, a lower parafoveal DVD (p = 0.001) was detected; FAZ area was related to FMT (p = 0.025), and the postoperative BCVA was correlated with parafoveal DVD (p = 0.010) and FAZ area (p = 0.003). In macula-off RRD eyes, lower parafoveal SDV (p = 0.012), and foveal and parafoveal DVD (p = 0.012 and p < 0.001, respectively) were observed. BCVA was related to FAZ area (p = 0.012), foveal SVD (p = 0.005) and parafoveal DVD (p = 0.010). Conclusion: Rhegmatogenous retinal detachment eyes successfully treated with PPV had lower vessel density in the superficial and deep retinal plexus compared to fellow healthy eyes; BCVA was related to FAZ area and vessel density.

<p>Retinal Microvasculature Changes After Repair of Macula-off Retinal Detachment Assessed with Optical Coherence Tomography Angiography</p>

“…Our results build on the few recent reports that have investigated mac-off RRD eyes following repair using OCT-A. 28,29,31,32 We herein explore the various suggested mechanisms for the microvascular changes observed even following surgical repair of RRD including the effect of the RD itself, the effect of our surgical intervention for RD repair and the effect of macular detachment on the retinal microvasculature. A neurosensory RD is thought to lead to outer retinal ischemia, although the exact mechanism is not completely understood.…”

“…It has been extensively investigated in macular degeneration, retinal vein occlusion, diabetic retinopathy, posterior uveitis and optic neuropathies. [22][23][24][25][26][27] Recently, few reports investigated OCT-A parameters after mac-on [28][29][30] or mac-off 28,29,31,32 RD repair including vascular density (VD) and FAZ area and correlated those with visual function. Building on those reports, we herein employed OCT-A to evaluate microvascular changes in the superficial (SCP) and deep capillary plexuses (DCP), choriocapillaris and the FAZ area and their correlation with final best corrected visual acuity (BCVA) in eyes after mac-off RRD repair using the fellow eyes as controls.…”

Smaller Foveal Avascular Zone in Deep Capillary Plexus Is Associated with Better Visual Acuity in Patients after Macula-off Retinal Detachment Surgery

“…These contradicting results can be explained by differences in control groups. Identical to our study, Bonfiglio et al 19 measured the healthy fellow eye of the macula-off RRD patients as control. This method is appropriate because the FAZ has been shown to be similar in both eyes of healthy volunteers, but varies among individuals.…”

“…The current literature reports contradicting results regarding the FAZ after surgery for macula-off RRD. One study 19 reported no difference in FAZ between macula-off RRD eyes and control eyes, and two other studies 15,17 reported larger FAZ in macula-off RRD eyes compared with control eyes. These contradicting results can be explained by differences in control groups.…”

“…12 Earlier studies have evaluated the FAZ and VD in the superficial capillary plexus and DCP after maculaoff RRD surgery, but no study has evaluated these two parameters in the three distinct plexuses. [13][14][15][16][17][18][19] Photoreceptors receive most of their oxygen from the choroid and about 15% from the DCP. 20 During an RRD, damage to photoreceptor outer segments occurs within 12 hours owing to separation from the choroid, which results in apoptosis of photoreceptors.…”