Visual Prognosis and Foveal Reattachment After Reattachment Surgery in Macula-off Retinal Detachment

Hyo Jin Hyun; Byung Jae Sohn; Dong Ho Park; Jae Pil Shin; Si Yeol Kim

doi:10.3341/jkos.2010.51.4.558

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Hyun, Sohn, Park, Shin, and Kim: Visual Prognosis and Foveal Reattachment After Reattachment Surgery in Macula-off Retinal Detachment

Original Article

J Korean Ophthalmol Soc 2010;51(4):558-567.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.4.558

Visual Prognosis and Foveal Reattachment After Reattachment Surgery in Macula-off Retinal Detachment

Hyo Jin Hyun, MD, Byung Jae Sohn, MD, Dong Ho Park, MD, Jae Pil Shin, MD, Si Yeol Kim, MD

Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea

Address reprint requests to Jae Pil Shin, MD Department of Ophthalmology, Kyungpook National University Hospital #50 Samduk 2-ga, Jung-gu, Daegu 700-721, Korea TEL: 82-53-420-5817, FAX: 82-53-426-6552, E-Mail: jpshin@hitel.net

Received 24 July 2009 Accepted 22 December 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the visual prognosis and time course of the foveal reattachment according to operation methods and pre-operative factors using optical coherence tomography (OCT) after successful reattachment surgery in cases of macula-off rhegmatogenous retinal detachment.

Methods

From Jan 2006 to Aug 2008, 47 patients who underwent retinal reattachment surgery for macula-off retinal detachment who were followed up for more than 12 months were enrolled in this study. Thirty patients underwent vitrectomy, and 17 patients underwent a scleral buckle procedure. Ophthalmological examinations, including best-corrected visual acuity, slit-lamp examination, fundus examination, and OCT, were performed before surgery and at 1, 1.5, 3, 6, and 12 months after surgery.

Results

The foveal reattachment time was shorter after vitrectomy than after the buckle procedure (p＜0.05). Postoperative visual acuity was better when the height of the detached fovea, as viewed by OCT, was shorter, although foveal reattachment time was not related to visual prognosis.

Conclusions

OCT may help to predict visual outcome and to assess macular changes in patients with macula-off retinal detachment after successful reattachment surgery.

Keywords: Foveal reattachment, Optical coherence tomography, Retinal detachment

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Figure 1.

Scatterplot illustrating the relation between postoperative best-corrected visual acuity (BCVA, LogMAR) and height of foveal detachment (μm) in optical coherence tomography (OCT).

Figure 2.

Scatterplot illustrating the relation between improvement of best-corrected visual acuity (BCVA, LogMAR) and foveal reattachment time (days) by optical coherence tomography (OCT) after buckling procedure.

Table 1.

Clinical characteristics of patients (I)

Variables			Data
Age (years)			35.6±18.9 (10–73)
Male/Female (No. of eyes)			28/19
Right/Left eye (No. of eyes)			22/25
Duration of symptom (days)			42.31±117.5 (3–730)
Extent of retinal detachment (hours)			5.49±1.99 (2∼12)
Phakia/Pseudophakia (No. of eyes)			40/7
Preoperative BCVA^* (LogMAR)			1.27±0.79 (0.3–2.6)
Operation methods			No. of eyes (%)
Encircling buckle	with subretinal fluid drainage		7 (14.9%)
	without subretinal fluid drainage	C3F8 gas^† (+)	1 (2.1%)
		C3F8gas (−)	3 (6.4%)
Segmental buckle	with subretinal fluid drainage	C3F8 gas (+)	3 (6.4%)
		C3F8 gas (−)	7 (14.9%)
	without subretinal fluid drainage	C3F8 gas (+)	1 (2.1%)
		C3F8 gas (−)	8 (17.0%)
Vitrectomy with fluid gas exchange			17 (36.2%)

Data are presented as mean± SD (range) unless otherwise indicated

^* BCVA=best-corrected visual acuity

^† C3F8 gas=C3F8 gas

Table 2.

Clinical characteristics of patients (II)

Variables	Results	P-value^*
Preoperative BCVA^† (LogMAR)	1.27±0.79
Postoperative BCVA (LogMAR)
1 month	1.01±0.59	0.034
3 months	0.528±0.39	<0.0001
6 months	0.363±0.38	0.004
12 months	0.369±0.38	0.02
Height of foveal detachment (μm)
1 month	37.73±56.93 (0∼157)
3 months	19.74± 42.2 (0∼132)	<0.0001
6 months	3.68±17.84 (0∼99)	0.018
Timing of foveal reattachment by OCT^‡ (	days) 68.29.14±63.7 (4∼210)

Data are presented as mean± SD (range) unless otherwise indicated

^* Two-sample T test

^† BCVA=best-corrected visual acuity

^‡ OCT=optical coherence tomography.

Table 3.

Comparison between vitrectomy and scleral buckling procedure

	Vitrectomy (n=17)	Scleral Buckle (n=30)	P-value
Age (years)	50.71±12.36	27.07±16.62	<0.0001^*
Extent of retinal detachment (hours)	5.17±1.77	5.67±2.12	0.557^*
Duration of Symptom (days)	12.06±21.48 (1–90)	59.47±144.17 (3–730)	0.007^*
Lens status (n, %)
Phakia	11 (64.7%)	29 (96.7%)	0.006^†
Pseudophakia	6 (35.3%)	1 (3.3%)	0.006^†
Preoperative BCVA^‡ (LogMAR)	1.62±0.76	1.08±0.74	0.019^*
Postoperative BCVA (LogMAR)
1 month	1.27±0.70	0.96±0.51	0.122^*
3 months	0.59±0.36	0.54±0.43	0.588^*
6 months	0.43±0.38	0.44±0.52	0.624^*
12 months	0.399±0.44	0.317±0.22	0.670^*
Improvement of BCVA (LogMAR)	–1.36±0.68	–0.78±0.7	0.005^*
Timing of foveal reattachment by OCT^§ (days)	37.06±16.87 (1–90)	86±73.37 (4–300)	0.013^*
Foveal reattachment by OCT in less than 6 weeks (n, %)	17 (100%)	15 (50%)	<0.0001^†

Data are presented as mean± SD (range) unless otherwise indicated

^* Mann-Whitney U test

^† Fisher's exact test

^‡ BCVA=best-corrected visual acuity

^§ OCT=optical coherence tomography.

Table 4.

Comparison between encircling and segmental scleral buckle

	Encircling buckle (n=11)	Segmental buckle (n=19)	P-value
Age (years)	17.90±7.34	32.37±18.28	0.012^*
Extent of retinal detachment (hours)	6.36±2.62	5.26±1.73	0.25^*
Duration of symptom (days)	123.54±228.03 (3–730)	22.37±25.28 (4–75)	0.35^*
Preoperative BCVA^‡ (LogMAR)	1.27±0.56	0.97±0.82	0.103^*
Postoperative BCVA (LogMAR)
1 month	1.04±0.61	0.82±0.46	0.42^*
3 months	0.63±0.57	0.45±0.31	0.553^*
6 months	0.55±0.62	0.28±0.27	0.307^*
12 months	0.58±0.62	0.29±0.19	0.372^*
Improvement of BCVA (LogMAR)	–0.76±0.52	–0.79±0.79	0.672^*
Timing of foveal reattachment by OCT^§ (days)	57.27±60.67 (5–180)	102.6±76.4 (4–300)	0.052^*
Foveal reattachment by OCT at 1 month (n, %)	9 (81.8%)	6 (31.6%)	0.021^†

Data are presented as mean± SD (range) unless otherwise indicated

^* Mann-Whitney U test

^† Chi-square test

^‡ BCVA=best-corrected visual acuity

^§ OCT=optical coherence tomography.

Table 5.

Comparison between the patients with symptom duration of retinal detachment less than one week and more than one week in buckle procedure

	Duration of symptom (< 1 week)	Duration of symptom (≥ 1 week)	P-value^*
No. of eyes	14	16
Age (years)	28.14±18.60	26.12±15.24	0.822
Extent of retinal detachment (hours)	4.71±1.49	6.5±2.28	0.019
Duration of symptom (days)	5.5±1.40	106.69±187.31	<0.0001
Preoperative BCVA^† (LogMAR)	1.11±0.91	1.05±0.59	0.854
Postoperative BCVA (LogMAR)
1 month	0.65±0.28	1.12±0.59	0.028
3 months	0.37±0.22	0.64±0.51	0.142
6 months	0.26±0.26	0.47±0.55	0.400
12 months	0.26±0.21	0.52±0.55	0.193
Improvement of BCVA (LogMAR)	–0.92±0.86	–0.67±0.52	0.448
Timing of foveal reattachment by OCT^‡ (days)	98.57±73.89	75±73.48	0.525

Data are presented as mean± SD unless otherwise indicated

^* Mann-Whitney U test

^† BCVA=best-corrected visual acuity

^‡ OCT= optical coherence tomography.

Table 6.

Comparison between retinal detachment with demarcation line and without demarcation line in scleral buckle procedure

	Retinal detachment with demarcation line (n=16)	Retinal detachment without demarcation line (n=14)	P-value
Age (years)	29.93±18.69	23.79±13.84	0.377^*
Extent of retinal detachment (hours)	6.06±2.35	5.21±1.81	0.400^*
Duration of symptom (days)	95.68±191.44	18.07±24.93	0.047^*
Preoperative BCVA^‡ (LogMAR)	1.03±0.68	1.14±0.82	0.729^*
Improvement of BCVA (LogMAR)	–0.63±0.62	–0.96±0.77	0.131^*
Postoperative BCVA (LogMAR)
1 month	0.98±0.60	0.81±0.41	0.498^*
3 months	0.63±0.53	0.38±0.19	0.208^*
6 months	0.47±0.57	0.27±0.21	0.637^*
12 months	0.48±0.57	0.30±0.21	0.608^*
Timing of foveal reattachment by OCT^§ (days)	76.88±76.66	96.43±70.78	0.400^*
Encircling buckle (n, %)	5 (31.3%)	8 (57.1%)	0.390^†
SRF^∏ drainage (+) (n, %)	10 (62.5%)	7 (50%)	0.626^†
C₃ F₈ gas^∏ (+) (n, %)	1 (6.3%)	4 (28.6%)	0.433^†

Data are presented as mean± SD unless otherwise indicated

^* Mann-Whitney U test

^† Fisher's exact test

^‡ BCVA=best-corrected visual acuity

^§ OCT=optical coherence tomography

^∏ SRF =subretinal fluid

^＃ C3F8 gas=C3F8 gas tamponade.

Table 7.

Comparison between scleral buckle procedure with subretinal fluid (SRF) drainage and without subretinal fluid drainage

	Buckle procedure with SRF drainage	Buckle procedure without SRF drainage	P-value^*
No. of eyes	17	13
Age (years)	29.76±19.11	23.54±12.53	0.621
Extent of retinal detachment (hours)	5.53±2.37	5.85±1.81	0.509
Duration of symptom (days)	83.65±189.05	27.85±25.84	0.281
Preoperative BCVA† (LogMAR)	1.38±0.79	0.68±0.45	0.009
Postoperative BCVA (LogMAR)
1 month	0.92±0.57	0.87±0.47	0.805
3 months	0.58±0.47	0.43±0.34	0.341
6 months	0.49±0.53	0.23±0.24	0.170
12 months	0.48±0.54	0.29±0.23	0.509
Improvement of BCVA (LogMAR)	–1.01±0.80	–0.49±0.41	0.043
Timing of foveal reattachment by OCT^‡ (days)	91.76±73.84	78.46±75.04	0.773

Data are presented as mean± SD unless otherwise indicated

^* Mann-Whitney U test

^† BCVA=best-corrected visual acuity

^‡ OCT= optical coherence tomography.

Table 8.

Comparison between the timing of foveal reattachment within one month and more than one month in scleral buckle procedure

	Timing of foveal	Timing of foveal
	reattachment by OCT	reattachment by OCT	P-value
	(≤ 1 month)	(> 1 month)
No. of eyes	15	15
Age (years)	29.46±18.67	26.21±16.22	0.41^*
Extent of retinal detachment (hours)	6.20±2.65	5.13±1.30	0.36^*
Duration of symptom (days)	94.06±199.32	24.87±27.59	0.54^*
Preoperative BCVA^‡ (LogMAR)	1.19±0.70	0.97±0.79	0.30^*
Postoperative BCVA (LogMAR)
1 month	1.04±0.55	0.76±0.47	0.14^*
3 month	0.55±0.52	0.48±0.30	0.97^*
6 month	0.53±0.54	0.23±0.26	0.07^*
12 month	0.52±0.57	0.28±0.19	0.32^*
Improvement of BCVA (LogMAR)	–0.77±0.66	–0.79±0.76	0.93^*
SRF^§ drainage (+) (n, %)	9 (52.94%)	8 (47.06%)	1.0^†
C₃ F₈ gas^∏ (+) (n, %)	3 (60%)	2 (40%)	1.0^†
Retinal detachment with demarcation line (n, %)	9 (56.25%)	7 (43.75%)	0.72^†

Data are presented as mean± SD unless otherwise indicated

^* Mann-Whitney U test

^† Fisher's exact test

^‡ BCVA=best-corrected visual acuity

^§ SRF=subretinal fluid

^∏ C3F8 gas=C3F8 gas tamponade.

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