Postoperative complications after successful primary rhegmatogenous retinal detachment repair

Abstract

Background: To evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD).

Methods: Retrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD "pending foveal detachment" subgroup.

Results: Sixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6).

Conclusions: The risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.

Keywords: Cystoid macular edema; Epiretinal membrane; Internal limiting membrane; Pars plana vitrectomy; Rhegmatogenous retinal detachment; Scleral buckling.

Fig. 1

Macula status rhegmatogenous retinal detachment (RRD) patterns A: macula-on “properly so-called”; B: macula-on “pending foveal detachment”; C: macula-off) and postoperative complications (D: Cystoid macular edema with subretinal fluid; E. Cystoid macular edema with epiretinal membrane; F: Epiretinal membrane)

Fig. 2

Changes of best-corrected visual acuity (LogMar) in surgical groups (scleral buckling Vs. pars plana vitrectomy) stratified for macula status (macula-on and macula-off)

Fig. 3

Cystoid Macular Edema (CME) characteristics. A Incidence of CME in surgical groups; B Relation between best-corrected visual acuity and central foveal thickness; C Best-corrected visual acuity in patients with or without CME)

Fig. 4

Frequency (%) of cystoid macular edema (CME) in patients with macula-on and macula-off rhegmatogenous retinal detachment (A); in patients who underwent pars plana vitrectomy (PPV) with or without phacoemulsification and intraocular (IOL) implantation (B); in patients who underwent PPV with or without internal limiting membrane (ILM) peeling (C)

Fig. 5

Epiretinal membrane (ERM) frequency (%) in surgical groups (scleral buckling Vs. pars plana vitrectomy) (A); in patients affected by macula-on and macula-off rhegmatogenous retinal detachment (RRD) (B); in patients who underwent pars plana vitrectomy with and without internal limiting membrane (ILM) peeling (C)