Author: Sho Noji (Japan)
Co-authors: Akito Hirakata, Makoto Inoue, Takashi Koto, Masaharu Mizuno
Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment (RRD) has been described as multiple subretinal fluid blebs (MSFB). MSFB has been reported to be hyperfluorescent lesion in lipofuscin-related fundus autofluorescence (FAF). We investigated the incidence and clinical characteristics of MSFB after pars plana vitrectomy (PPV) for RRD.
Retrospective case control study, single academic institute, Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan.
We reviewed the medical records of patients who underwent PPV (25- or 27-gauge) to RRD in our hospital between April 2019 and August 2020. The patients who were followed for less than 6 months were excluded. MSFB were determined by fundus examination and optical coherence tomography. Clinical characteristics including age, sex, axial length, duration of symptom from onset to surgery, baseline macular status, and best-corrected visual acuity (BCVA) in logMAR unit before and after surgery, images of FAF (Optos, Optos Inc, Marlborough, MA) and near-infrared fundus autofluorescence (NIFAF, Heidelberg Retina Angiograph 2, Heidelberg) were compared with MSFB (MSFB group) and without MSFB (control group).
A total of 224 eyes of 224 patients (155 men and 59 women; mean age of 59.1±9.5 years) were included in the study. Retina reattached in all eyes after the initial surgery and MSFB were observed in 27 eyes (12.1%). BCVA improved significantly f after 6 months in the MSFB group (0.48±0.44 to 0.04±0.12, p <0.0001) and control groups (0.64±0.69 to 0.06±0.22, p <0.0001), but the preoperative and postoperative BCVA were not significant between the groups (p=0.702, p=0.337). The MSFB lesions decreased over time and MSFB had completely resolved in 20 eyes (74.1%) at 6 months after surgery. The incidences of macula-off RRD (85%) and preoperative precipitate (41%) were significantly higher in the MSFB group than that of control group (64%; p=0.046, 12%; p=0.002, respectively). The axial length was significantly shorter in the MSFB group than that of the control group (25.04±1.54mm, 26.00±1.78 mm, p=0.12). The lesion of MSFB was hyperfluorescence in FAF in 24 eyes (89%) and hypofluorescence in 3 eyes (11.1 %). The hypofluorescent lesions in FAF were observed to be hyperfluorescence in NIFAF in all 3 eyes.
The incidence of MSFB was higher in eyes with macular-off RRD, preoperative precipitate, and shorter axial length. The MSFB lesions consisted of two components of lipofuscin-related hyperfluorescent subretinal fluid and melanin-related hyperfluorescent NIFAF lesion of subretinal proliferation of retinal pigment epithelium cells.