Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 25;7(1):9.
doi: 10.1186/s40942-020-00254-9.

Macular edema after rhegmatogenous retinal detachment repair: risk factors, OCT analysis, and treatment responses

Cameron Pole  1 , Ismael Chehaibou  1   2 , Andrea Govetto  3 , Sean Garrity  4 , Steven D Schwartz  1 , Jean-Pierre Hubschman  5
Affiliations

Macular edema after rhegmatogenous retinal detachment repair: risk factors, OCT analysis, and treatment responses

Cameron Pole et al. Int J Retina Vitreous. .

Abstract

Purpose: To investigate risk factors, imaging characteristics, and treatment responses of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair.

Methods: Consecutive, retrospective case-control series of patients who underwent pars plana vitrectomy (PPV) and/or scleral buckling (SB) for RRD, with at least six months of follow-up. Clinical and surgical parameters of patients with and without CME (nCME), based on spectral-domain optical coherence tomography (OCT), were compared.

Results: Of 99 eyes enrolled, 25 had CME while 74 had nCME. Patients with CME underwent greater numbers of surgeries (P < 0.0001). After adjusting for number of surgeries, macula-off RRD (P = 0.06), proliferative vitreoretinopathy (PVR) (P = 0.09), surgical approach (PPV and/or SB, P = 0.21), and tamponade type (P = 0.10) were not statistically significant, although they all achieved significance on univariate analysis (P = 0.001 or less). Intraoperative retinectomy (P = 0.009) and postoperative pseudophakia or aphakia (P = 0.008) were more frequent in the CME group, even after adjustment. Characteristics of cCME on OCT included diffuse distribution, confluent cysts, and absence of subretinal fluid or intraretinal hyperreflective foci. Macular thickness improved significantly with intravitreal triamcinolone (P = 0.016), but not with anti-vascular endothelial growth factor agents (P = 0.828) or dexamethasone implant (P = 0.125). After adjusting for number of surgeries and macular detachment, final visual acuities remained significantly lower in the CME vs nCME group (P = 0.012).

Conclusion: Risk factors of CME include complex retinal detachment repairs requiring multiple surgeries, and pseudophakic or aphakic lens status. Although this cCME was associated with poor therapeutic response, corticosteroids were the most effective studied treatments.

Keywords: Corticosteroids; Intravitreal injection; Macular edema; Retinal detachment; Spectral-domain optical coherence tomography; Vitrectomy.

PubMed Disclaimer

Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection process. ICD-9: International Classification of Disease, 9th edition. CPT Current Procedural Terminology, CME Cystoid Macular Edema
Fig. 2
Fig. 2
Spectral-domain optical coherence tomography and infrared image elevation overlays of two different patients with chronic cystoid macular edema post-rhegmatogenous retinal detachment. The scan in Row A demonstrates schisis-like changes. The scan in Row B demonstrates confluent cystic cavities spanning retinal layers that developed over two years. In both scans, note diffuse, asymmetric distribution of retinal cysts crossing the horizontal raphe, involvement of inner and outer retinal layers, absence of subretinal fluid, and relative preservation of outer retinal bands subjacent to retinal edema
Fig. 3
Fig. 3
Spectral-domain optical coherence tomography (OCT) images of chronic cystoid macular edema (CME) post-rhegmatogenous retinal detachment (RRD) repair of the left eye, with dates and visual acuities (VA). Panel A: OCT prior to dexamethasone implant (DEX) injection. Panel B: OCT 1 month after DEX injection, showing resolution of CME but retinal layer atrophy. Modest VA improvement was noted. Panel C: OCT four months after injection, showing recurrence of CME in a similar distribution and slight decrease in VA
See this image and copyright information in PMC

Comment in

References

    1. Daruich A, Matet A, Moulin A, et al. Mechanisms of macular edema: beyond the surface. Prog Retin Eye Res. 2018;63:20–68. doi: 10.1016/j.preteyeres.2017.10.006. - DOI - PubMed
    1. Spaide RF. Retinal vascular cystoid macular edema: review and new Theory. Retina. 2016;36(10):1823–1842. doi: 10.1097/IAE.0000000000001158. - DOI - PubMed
    1. Romano V, Angi M, Scotti F, et al. Inflammation and macular oedema after pars plana vitrectomy. Mediators Inflamm. 2013;2013:971758. - PMC - PubMed
    1. Catier A, Tadayoni R, Paques M, et al. Characterization of macular edema from various etiologies by optical coherence tomography. Am J Ophthalmol. 2005;140(2):200–206. doi: 10.1016/j.ajo.2005.02.053. - DOI - PubMed
    1. Bonnet M. Prognosis of cystoid macular edema after retinal detachment repair. Graefes Arch Clin Exp Ophthalmol. 1986;224(1):13–17. doi: 10.1007/BF02144125. - DOI - PubMed