Author: Nuria Torrell Belzach (Spain)
Co-authors: José Ignacio Vela Segarra, Jaume Crespí Vilimelis, Alicia López De Eguileta, Mohammed Alhayek, Ester Mingorance Moya
To describe the incidence, characteristics and possible factors associated of persistent subretinal fluid (SRF) following surgery of rhegmatogenous retinal detachment (RRD).
Single-center, multi-surgeon retrospective analysis of case series with SRF following RRD repair, either with 23 G pars plana vitrectomy (PPV) or 23G PPV combined with a scleral buckle, at a major tertiary hospital in Barcelona, Spain.
160 consecutive patients with RRD underwent either 23G PPV or 23PPV combined with a scleral buckle in Santa Creu i Sant Pau Hospital (Barcelona) were retrospectively reviewed. Different parameters were analysed regarding RRD characteristics, type of surgery, localization, SRF extension and course length. Postoperative outcomes including visual acuity (VA) and anatomical changes, using spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) images, were also reported. All patients were treated intraoperatively with endophotocoagulation and gas tamponade with 24% SF6 at the end of surgery except for one who was treated with scleral buckle and cryopexy.
A total of 24/160 eyes were identified with persistent SRF (15%) with an average age of 61.5y (range 40-81y). 11 of these eyes were treated with 23G VPP alone, 12 were treated with 23GVPP and scleral buckle combined and just 1 was treated with scleral buckle alone. Of all these patients, 19/160 were macula-off RRD (11.9%) and 5/160 were macula-on RRD (3.1%). SRF was observed clinically and in SD-OCT in an average of 1.9 months after surgery (range 1-5.5 months). Subfoveal localization was detected in 6/24 patients (25%), extrafoveal localization in 6/24 patients (25%) and a combination of the two in 12/24 patients (50%). FAF images were obtained from some of the patients, showing complete SRF extension. SRF of all patients resolved starting at the fourth month, with an average of 8.7 months (range 4-21 months). Statistical significative difference was found between different treatment groups, presenting resolution in 10 months in those treated with 23G VPP and only in 5 months in those treated with 23G VPP combined with scleral buckling (p=0.026, U Mann-Whitney). Finally, the average VA (logMAR) improvement at SRF resolution was of 0.15.
Persistent SRF is frequently found after RRD surgery, in our study the incidence was 15%, and it slowly resolves without any treatment with a good visual prognosis, and it does more rapidly in patients treated with 23G VPP combined with scleral buckling. SD-OCT is strongly recommended in postoperative visits of patients who underwent a previous RRD surgery to exclude SRF. In those patients with extramacular SRF, FAF imaging could have an important role in determining total fluid extension and in monitoring progressive resolution.