Anatomy and function of the macula in patients after retinectomy for retinal detachment complicated by proliferative vitreoretinopathy.

PURPOSE

To investigate the anatomy and function of the macula in patients after retinectomy for retinal detachment complicated by proliferative vitreoretinopathy (PVR) grade C.

METHODS

A prospective study involving 25 patients operated with vitrectomy and retinectomy due to retinal detachment complicated by PVR grade C. Outcome measures included preoperative and postoperative best-corrected visual acuity (BCVA) at 6 months and the difference between preoperative and postoperative BCVA. Furthermore, the macular status was analyzed on postoperative optical coherence tomography (OCT) scans.

RESULTS

Reattachment was observed in 96% (24/25) of patients. Median BCVA improved from 2.30 logMAR (range 1.00 to 2.69 logMAR) to 1.00 logMAR (range 0.38 to 2.90 logMAR). The change from preoperative visual acuity was statistically significant (p=0.0003, Wilcoxon signed rank test). Macular status with pathologies was observed in 75% of eyes on OCT (retinal pigment epithelium irregularities 37.5%, cystoid macular edema 33%, epiretinal membrane 8.3%, subretinal fluid 4%, and subretinal perfluorocarbon liquid 4%). These eyes had significantly worse final visual acuity (p=0.01, Wilcoxon rank sum test) compared to those with a clinically normal macula. The retinectomy size influenced neither visual acuity (p=0.06, Wilcoxon rank sum test) nor incidence of normal macular status (p=0.14, Fisher exact test).

CONCLUSIONS

Even though retinectomy is an effective technique to reattach the retina in complicated cases of retinal detachment, the functional outcome was found to be influenced by abnormal macular status, observed in 75% of eyes. Moreover, 360-degree retinectomies did not show different anatomic or functional results vs subtotal ones.