Scleral buckling versus vitrectomy for macula-off rhegmatogenous retinal detachment as accessed with spectral-domain optical coherence tomography: a retrospective observational case series

Abstract

Background: Scleral buckling surgery and pars plana vitrectomy are competing methods in the treatment of retinal detachment. The recent development of spectral-domain optical coherence tomography (SD-OCT) has dramatically improved the visualization of the photoreceptor layer relative to conventional OCT, and offers new opportunities to investigate the discordances between anatomic and functional outcomes after retinal detachment surgery. Hence, the study aim was to use SD-OCT to compare the postoperative macular recovery between scleral buckling and vitrectomy for macular-off rhegmatogenous retinal detachment.

Methods: In this retrospective observational case series, we observed 32 patients who underwent scleral buckling surgery (group 1) and 26 patients who underwent pars plana vitrectomy (group 2) as the primary surgery for macula-off rhegmatogenous retinal detachment. OCT was used to examine microstructural changes in the macular area.

Results: The mean visual acuity improvement was 0.4 ± 0.8 logMAR in group 1 and 0.7 ± 0.9 logMAR in group 2. As detected by SD-OCT, subretinal fluid was present in 26 of the group 1 eyes (81.3%) and 5 of the group 2 eyes (19.2%) at 8 weeks postoperatively.This difference was statistically significant (Fisher's exact test, P < 0.05). Moreover, detection by SD-OCT revealed epiretinal membranes in 5 of the group 1 eyes (15.6%) and 11 of the group 2 eyes (42.3%), a difference that was statistically significant (Fisher's exact test, P < 0.05).

Conclusions: Macular recovery and the mean visual acuity differed between the 2 groups of patients. With the help of SD-OCT, we observed that subretinal fluids could persist for a relatively longer period after scleral buckling. Based on our results, we conclude that primary vitrectomy surgery is a better choice for macular recovery of the macula-off rhegmatogenous retinal detachment.

Figure 1

Optical coherence tomographic images of preoperative and postoperative retinas. A-C: Shows a patient from the SB group. The patient was a 34 year old female, with Poor visual acuity (VA) and metamorphopsia for 15 days before operation. A. The best-corrected visual acuity (BCVA) among the preoperative retinas was 2.0. B. Typical residual retinal detachment can be seen 1 week after sclera bucking; the BCVA was 1.3. C, Typical residual retinal detachment can be seen 2 months after sclera bucking; the BCVA was 1.0. D-E: Shows a patient from the PPV group. The patient was a 42 years old female, with Poor visual acuity (VA) and metamorphopsia for 21 days before operation. D. Optical coherence tomographic images of a preoperative retina; the BCVA was 1.3. E. One month after primary vitrectomy operation, macular reattachment was successful in this patient, and no subretinal fluid was present; the BCVA was 0.3.