J Korean Ophthalmol Soc.  2009 Mar;50(3):399-404. 10.3341/jkos.2009.50.3.399.

Foveal Reattachment After Scleral Buckling vs Vitrectomy for Macula-Off Retinal Detachment

• Ku M
• Sohn HJ
• Lee DY
• Nam DH

• KMID: 2111250
• DOI: http://doi.org/10.3341/jkos.2009.50.3.399

Abstract

PURPOSE: To compare the time course of foveal reattachment after successful surgery for macula-off retinal detachments by scleral buckling or pars plana vitrectomy (PPV).
METHODS
We retrospectively examined, using optical coherence tomography (OCT), the cross-sectional retinal images of 28 patients who underwent scleral buckling or PPV for macula-off retinal detachment and whose retinas reattached upon binocular stereoscopic indirect ophthalmoscopy within 4 weeks postoperatively. All eyes underwent clinical examination and OCT scan of the macula at 6 weeks after surgery. If subretinal fluid persisted, repeated OCT was obtained at every 1~2 months until no abnormality was seen on OCT. Demographic data, including detachment characteristics, was also analyzed.
RESULTS
On postoperative OCT examination 6 weeks after surgery, complete foveal reattachments were detected in 14 patients (73.7%) in the PPV group (n=19), significantly higher than 3 (33.3%) patients in the buckling group (n=9). Foveal reattachment took a mean 8.31+/-5.25 weeks in the PPV group and a mean 20.89+/-11.37 weeks in the buckling group.
CONCLUSIONS
Foveal reattachment after macula-off retinal detachment occurred faster after PPV than after buckle surgery.

Keyword

Macula detachment; Optical coherence tomography; Retinal detachment; Subfoveal fluid

MeSH Terms

Eye
Humans
Ophthalmoscopy
Retina
Retinal Detachment
Retinaldehyde
Retrospective Studies
Scleral Buckling
Subretinal Fluid
Telescopes
Tomography, Optical Coherence
Vitrectomy
Retinaldehyde

Figure

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  Figure 1. Foveal reattachment rate on optical co-herence tomography (OCT) at 6 weeks post-operatively. Vitrectomy group: fourteen of 19 patients showed reattachment and persistent foveal detachment was detected in 5 patients. Scleral buckle group: only three patients were shown to be reattached at 6 weeks. Statistical analysis was performed by Mann-Whitney test (p<.01).

• 

  Figure 2. Typical optical coherence tomography (OCT) appearance in a case treated with PPV. A. Preoperative OCT scan of a 63-year-old patient showing a high foveal detachment. Preoperative visual acuity was 1.1 logMAR. B. OCT image of the same patient 6 weeks after vitrectomy. The fovea is completely flat, and the vision has improved to 0.5 logMAR.

• 

  Figure 3. Typical optical coherence tomography (OCT) appearance in a case treated with buckling. (A) Preoperative OCT scan of a 27-year-old patient showing a high foveal detachment with loss of the foveal architecture. Preoperative visual acuity was 1.1 logMAR. (B) OCT image of the same patient 6 weeks after successful reattachment of the macula-off retinal detachment using a circumferential buckle (506 silicone band) showing a residual circumscribed foveal detachment. (C) OCT image of the same patient 6 months after surgery. The circumscribed foveal detachment is still present. Visual acuity is still remained at 0.4 logMAR. (D) The residual foveal detachment has almost completely disappeared and visual acuity has improved to 0.2 logMAR.

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  Figure 4. The course of cumulative foveal reattach-ment rate during the 42 postoperative weeks. At 22 postoperative weeks, all patients showed foveal reattachment on optical coherence tomography (OCT) in vitrectomy group, whereas only 44.4% in buckle group.

Reference

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