Macular microcirculation changes after macula-off rhegmatogenous retinal detachment repair with silicone oil tamponade evaluated by OCT-A: preliminary results

Abstract

Background: Rhegmatogenous retinal detachment (RRD) with macular involvement is a sight-threatening condition. Silicone oil (SO) is efficacious for retinal tamponade, especially in complex cases. Whether macular detachment per se or the potential tamponading agent may affect macular microcirculation after RRD repair is a matter of research.

Objectives: To investigate macular microcirculation changes using optical coherence tomography angiography (OCT-A) after pars plana vitrectomy (PPV) with intravitreal SO for RRD repair in the early posttreatment period.

Design: Prospective comparative cross-sectional study.

Data sources and methods: Fourteen eyes of 14 patients were included in the study. All eyes underwent a single successful PPV with SO tamponade for macula-off RRD. OCT-A was performed to analyze macular microcirculation and visual outcomes at 1 month postoperatively. The fellow unaffected eye was used as control.

Results: Vessel density (VD) in the superficial capillary plexus (SCP) was significantly lower at each macular region (fovea, parafovea, and perifovea) of SO-treated eyes compared with the fellow eyes (all p = 0.001). Similarly, perfusion density (PD) in the SCP was significantly lower at each macular region than the fellow eyes (all p = 0.001). There was enlargement of foveal avascular zone (FAZ) area and decrease of circularity at RRD eyes compared with the fellow ones (all p = 0.001). Postoperative logMAR visual acuity (VA) was significantly lower in treated eyes than fellow eyes and correlated inversely with foveal, parafoveal, and perifoveal VD and PD SCP (all p < 0.001). Postoperative VA had no correlation with FAZ parameters.

Conclusion: Enlargement of FAZ SCP and decrease in VD and PD SCP during the short-term follow-up were possibly attributable to ischemic changes in the macular area after RRD repair with SO tamponade. In this preliminary study, the flow density in macular capillary plexus may represent an indicator of visual outcomes.

Keywords: macula-off; macular capillary plexus; optical coherence tomography angiography; rhegmatogenous retinal detachment; silicone oil.

Figure 1.

Mean plot of 1-month postoperative OCT-A characteristics in RRD eyes and unaffected fellow eyes. (a) One-month postoperative FAZ area (mm²) and circularity from RRD and fellow eyes. All p ⩽ 0.001. (b) One-month postoperative VD (mm/mm²) in each macular region (outer, inner, central) from RRD and fellow eyes. All p ⩽ 0.001. (c) One-month postoperative FD (%) in each macular region (outer, inner, central) from RRD and fellow eyes. All p ⩽ 0.001.

Figure 2.

Correlation analyses of 1-month postoperative OCT-A characteristics with VA (logMAR). (a) No correlation of VA with 1-month postoperative FAZ area (p = 0.365) and 1-month postoperative FAZ circularity with VA (p = 0.233). (b) Negative correlation of 1-month postoperative VD at each macular region (outer, inner, central) with VA, all p ⩽ 0.001. (c) Negative correlation of 1-month postoperative PD at each macular region (outer, inner, central) with VA, all p ⩽ 0.001.

Figure 3.

Representative images of foveal avascular zone (FAZ) in OCT-Angiography 6 × 6 mm² of (a) a patient with rhegmatogenous retinal detachment treated with intravitreal silicone oil, indicating enlargement of FAZ and decreased circularity and (b) the fellow unaffected eye.