Impact of Foveal Factors on Retinal Detachment Repair
Published online Jan. 29, 2021
Many pre-op factors have been shown to contribute to visual acuity (VA) results after treatment of retinal detachment (RDs), including symptom duration, baseline VA, and detachment height. Hostovsky et al. explored whether foveal features may have a similar correlation with post-op VA after macula-off RD repair. They found that foveal changes play a significant role in the pathogenesis of lost vision in such detachments, particularly those that are high and thus have greater tangential tension in the foveal region.
For this study, the authors reviewed medical records of 47 consecutive patients with a macula-off RD who presented during a two-month period. All had spectral-domain (SD) OCT imaging preoperatively. Parameters used to assess the fovea included RD height (measured manually), intraretinal morphologic changes, and foveal and subretinal pathologic features such as epiretinal membrane and macular hole (MH). All OCT findings were evaluated by Dr. Hostovsky, who was masked to the clinical data.
The majority (44 of 47) of affected eyes could be imaged by SD-OCT and were entered into the study. Six patients had MHs. Repair procedures were pneumatic retinopexy (n = 22), pars plana vitrectomy (n = 17), and scleral buckle (n = 5). All patients with MH received pneumatic retinopexy. According to univariate analysis, final visual outcomes correlated strongly with detachment height, symptom duration, and the presence of MH or epiretinal membrane (p = .001, .003 and .03, respectively). Also significant was the relationship between MH presence and RD height. Per multiple regression analysis, the only factor of these with a meaningful correlation to final VA was the presence of MH (p = .003) or epiretinal membrane (p = .007). Another significant relationship to final VA in multivariable analyses was success of the first surgery (p = .006).
The authors noted that the proportion of MHs, plus the correlation between MH and detachment height, may imply that elevated tension in the fovea of patients with high macula-off detachment leads to poorer visual outcomes after repair. The elevated tangential traction on the foveal region could cause MHs, said the authors.
The original article can be found here.