Evaluation of Subretinal fluid Drainage Techniques During Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment-ELLIPSOID Study

Abstract

Purpose: To compare visual acuity and photoreceptor integrity following pars plana vitrectomy with drainage from the peripheral retinal break(s) (PRB), posterior retinotomy (PR), or perfluorocarbon liquid (PFCL) for macula-off rhegmatogenous retinal detachment.

Design: Retrospective consecutive interventional comparative clinical study.

Methods: 300 consecutive patients (300 eyes) with primary macula-off rhegmatogenous retinal detachment underwent 23-gauge pars plana vitrectomy with subretinal fluid drainage through PRB (n = 100), PR (n = 100), or with PFCL (n = 100). Visual acuity and spectral-domain optical coherence tomography were performed preoperatively and at 3, 6, and 12 months postoperatively. Primary outcomes were visual acuity and discontinuity of the external limiting membrane, ellipsoid zone, interdigitation zone, and retinal pigment epithelium at 1 year.

Results: Baseline characteristics were similar. Single-operation reattachment rates were as follows: PRB 86%, PR 85%, and PFCL 83% (P = .9). Mean (±SD) logMAR visual acuity at 1 year was greater with PRB and PR compared with PFCL (PRB 0.6 ± 0.5, PR 0.7 ± 0.6, PFCL 0.9 ± 0.6, P = .002). There was an association between drainage technique and discontinuity of the external limiting membrane (PRB 26%, PR 24%, PFCL 44%, P = .001), ellipsoid zone (PRB 29%, PR 31%, PFCL 49%, P < .001), and interdigitation zone (PRB 43%, PR 39%, PFCL 56%, P = .004). There was an association between drainage technique and risk of cystoid macular edema (PRB 28%, PR 39%, PFCL 46%, P = .003) and epiretinal membrane (PRB 64%, PR 90%, PFCL 61%, P < .001).

Conclusions: PFCL-assisted drainage is associated with worse visual acuity and greater risk of outer retinal band discontinuity and cystoid macular edema compared with PRB or PR. PR had a greater risk of epiretinal membrane compared with PRB and PFCL. PRB had the best outcomes overall. Drainage technique may impact long-term anatomic and functional outcomes.