Ophthalmic Surgery, Lasers and Imaging Retina

Clinical Science 

Comparison of Residual Subfoveal Fluid by Intraoperative OCT After Macula-Involving RRD Repair Using Direct Drainage, Drainage Retinotomy, or Perfluoro-n-Octane

Anthony Obeid, MD; David Ehmann, MD; Murtaza Adam, MD; Sundeep Kasi, MD; Abtin Shahlaee, MD; Michael A. Klufas, MD; Jason Hsu, MD; Sonia Mehta, MD; Allen Chiang, MD; Sunir Garg, MD; Allen C. Ho, MD; Omesh P. Gupta, MD

Abstract

BACKGROUND AND OBJECTIVE:

This study evaluated the residual subfoveal fluid (SFF) immediately after rhegmatogenous retinal detachment (RRD) repair using intraoperative optical coherence tomography (iOCT).

PATIENTS AND METHODS:

This retrospective cohort study assessed fovea-involving RRD repaired by pars plana vitrectomy (PPV) using different drainage techniques. iOCT images were acquired through the fovea at the start of the case prior to initiating vitrectomy and then again immediately prior to introduction of tamponade.

RESULTS:

Ten eyes (32.3%) received perfluoro-n-octane (PFO), 12 (38.7%) underwent a posterior drainage retinotomy, and nine (29.0%) had drainage through the retinal break. There was no significant difference in the mean SFF thickness between eyes in either group (P = .85). There was no significant association between SFF thickness on iOCT and functional or anatomic outcomes (P > .05).

CONCLUSION:

There is no difference in the amount of residual SFF as measured on iOCT during RRD repair with pars plana vitrectomy using either direct drainage, drainage retinotomy, or PFO.

[Ophthalmic Surg Lasers Imaging Retina. 2019;50:497–503.]

Abstract

BACKGROUND AND OBJECTIVE:

This study evaluated the residual subfoveal fluid (SFF) immediately after rhegmatogenous retinal detachment (RRD) repair using intraoperative optical coherence tomography (iOCT).

PATIENTS AND METHODS:

This retrospective cohort study assessed fovea-involving RRD repaired by pars plana vitrectomy (PPV) using different drainage techniques. iOCT images were acquired through the fovea at the start of the case prior to initiating vitrectomy and then again immediately prior to introduction of tamponade.

RESULTS:

Ten eyes (32.3%) received perfluoro-n-octane (PFO), 12 (38.7%) underwent a posterior drainage retinotomy, and nine (29.0%) had drainage through the retinal break. There was no significant difference in the mean SFF thickness between eyes in either group (P = .85). There was no significant association between SFF thickness on iOCT and functional or anatomic outcomes (P > .05).

CONCLUSION:

There is no difference in the amount of residual SFF as measured on iOCT during RRD repair with pars plana vitrectomy using either direct drainage, drainage retinotomy, or PFO.

[Ophthalmic Surg Lasers Imaging Retina. 2019;50:497–503.]

Introduction

Intraoperative optical coherence tomography (iOCT) is a relatively new technology that has enabled real-time intraoperative imaging for ophthalmic surgeons. It has been used for anterior segment procedures including phacoemulsification, Descemet stripping automated endothelial keratoplasty (DSAEK), and deep anterior lamellar keratoplasty (DALK), as well as posterior segment vitreoretinal procedures such as macular peeling and retinal detachment surgery.1–4

Rhegmatogenous retinal detachment (RRD) results in an accumulation of fluid between the neurosensory retina and the retinal pigment epithelium (RPE) secondary to a retinal break. Pars plana vitrectomy (PPV) with or without a scleral buckle is the most common surgical procedure for RRD repair in the United States and abroad. Vitrectomy techniques allow for drainage of the subretinal fluid (SRF), application of retinopexy to the retinal breaks, placement of tamponade and re-attachment of the retina. The drainage of SRF can be accomplished using a number of intraoperative techniques, including direct drainage through the primary retinal defect, drainage through a surgically induced posterior retinotomy, or drainage using perfluoro-n-octane (PFO) to displace the SRF anteriorly through pre-existing retinal defects. Unfortunately, there are no studies that compare outcomes between the three drainage techniques.

Recent studies using iOCT have suggested that eyes receiving PFO for RRD repair demonstrate residual SRF after PFO fill and fluid-air exchange.1,5 However, residual subfoveal fluid (SFF) measured with iOCT following direct drainage through the primary retinal defect or through a posterior retinotomy has not been reported. More importantly, a comparison of the residual SFF between these techniques is lacking, and their potential impact upon postoperative outcomes remains unknown.

Using iOCT during RRD repair, we sought to compare the amount of residual SFF based on SRF drainage through the primary retinal defect, a posterior retinotomy, or using PFO. Furthermore, we explored potential associations between residual SFF and both functional and anatomic outcomes.

Patients and Methods

Approval from the institutional review board of Wills Eye Hospital was obtained prior to the commencement of this retrospective case series. Patients with a fovea-involving RRD repaired by PPV with or without a scleral buckle who underwent iOCT at the time of repair were identified from December 12, 2016, to February 27, 2017, and included in the study. The study was conducted in accordance with the Health Insurance Portability and Accountability Act of 1996 and adhered to the tenets of the Declaration of Helsinki. Inclusion criteria were: patients older than 18 years of age, diagnosis of an acute (< 2 weeks) primary fovea-involving RRD, and no prior history of a PPV. Patients were excluded if they had significant cataract and/or media opacity inhibiting visualization for iOCT image capture, proliferative vitreoretinopathy grade B or worse, presence of a full-thickness macular hole, or had received silicone oil. Patients were stratified based on the type of drainage technique utilized during surgery, which included direct drainage from the primary retinal defect, creation of a posterior drainage retinotomy, or the use of PFO. The type of drainage technique utilized was determined at the surgeon's discretion. In total, seven surgeons were involved in the study.

iOCT Imaging

iOCT images were acquired with the OMPI Lumera 7000 microscope with the Rescan 700 OCT (Carl Zeiss Meditec, Dublin, CA). Images were captured through the fovea at the start of each case prior to initiating vitrectomy. For patients receiving PFO, an iOCT image through the fovea was also taken after infusion of the PFO, but prior to the air-PFO-fluid exchange. All patients then had a final iOCT snapshot image taken after completion of air-fluid exchange, prior to introduction of the tamponade gas. SFF thickness was then measured with the straight-line function using ImageJ public domain software (National Institutes of Health, Bethesda, MD). As iOCT images lack pixel to micrometer conversion scales found on standard office-based OCT machines, SFF thickness was measured using the number of pixels from the inner hyperreflective layer of the RPE to the outer layer of the retina. All measurements were performed independently by two masked graders (DE and AS); the mean of each measurement was then calculated and utilized in the final analysis.

Spectral-domain OCT (SD-OCT) imaging (Spectralis HRA + OCT; Heidelberg Engineering, Heidelberg, Germany) was obtained at the final visit for eyes with successful reattachment. Scans were evaluated for the presence of SRF, intraretinal fluid (IRF), and epiretinal membrane (ERM). Images were also assessed for disruption of the ellipsoid zone, RPE, and external limiting membrane. Central subfield thickness was measured using the automated software package from the 25-line raster scan pattern (Heidelberg Eye Explorer; Heidelberg Engineering, Heidelberg, Germany).

Statistics

Statistical analyses were carried out using SAS 9.4 (SAS Institute, Cary, NC). Best-available Snellen visual acuities (VAs) based on spectacle correction or pinhole were converted to the logarithm of the minimum angle of resolution (logMAR) for analysis. Continuous variables were assessed for normal distribution using the Shapiro-Wilk test. Disparity in continuous variables between the three treatment arms was assessed using a one-way analysis of variance (ANOVA) test or the Kruskal-Wallis test for normally and not-normally distributed data, respectively. Paired comparisons were made using the paired t-test or the Wilcoxon signed-ranked test for normally and not-normally distributed data, respectively. Linear regression was used to evaluate the correlation between intraoperative SFF thickness post fluid-air exchange and both final logMAR VA and change in logMAR VA. Difference between the three treatment arms in postoperative re-detachment rate, presence of retinal cysts, ERM or SFF, as well as integrity of the outer retinal layers was assessed using a Chi-square test. A P value of less than .05 was determined to be statistically significant.

Results

Thirty-two eyes were initially identified to have undergone PPV with or without a scleral buckle and iOCT imaging for fovea-involving RRD repair during the study period. One eye was excluded for receiving silicone oil tamponade, leaving 31 eyes that were used in the final analysis. Baseline characteristics are summarized in Table 1. Mean (± standard deviation [SD]) follow-up post RRD repair was 3.7 (±1.4) months. The initial iOCT image at the beginning of the surgery was unobtainable in 14 eyes (45.2%) due to the bullous nature of the macula-off detachment. Of the 31 eyes, 10 (32.3%) received PFO, 12 (38.7%) underwent a drainage retinotomy, and 9 (29.0%) underwent direct drainage through the primary retinal defect. Six (19.4%) eyes had a re-detachment. There was no significant difference in re-detachment rates between eyes undergoing vitrectomy with PFO (two of 10, 20.0%), drainage retinotomy (two of 12 16.7%), and direct drainage from the retinal break (two of nine, 22.2%) (P = .95). Of the six eyes that re-detached, five had new breaks and one re-detached secondary to proliferative vitreoretinopathy.

Baseline Characteristics of Eyes Undergoing Retinal Detachment Repair Using iOCT Imaging, Mean (± SD) or N (%)

Table 1:

Baseline Characteristics of Eyes Undergoing Retinal Detachment Repair Using iOCT Imaging, Mean (± SD) or N (%)

Difference in Subfoveal Fluid

Following drainage and air-fluid exchange, there was no significant difference in the mean SFF thickness when comparing all three drainage groups (P = .85) (Figure 1). There was no significant difference in mean SFF following drainage and air-fluid exchange between phakic eyes (68.4 [±35.6]) and pseudophakic eyes (70.0 [±30.0]) (P = .91). In the subgroup of eyes receiving PFO, a significant increase in mean SFF thickness was observed after fluid-air exchange (72.1 [±42.1] pixels) when compared to the mean SFF thickness immediately after PFO infusion (31.5 [±10.6] pixels) (P = .01; n = 9) (Figure 2). In the subgroup of eyes that underwent a drainage retinotomy, there was a significant decrease in the mean SFF thickness from 120.6 (±36.7) pixels prior to vitrectomy to 65.4 (±29.9) pixels post air-fluid exchange (P = .045, n = 4) (Figure 3). For eyes that underwent direct drainage through the primary defect, there was no significant difference in mean SFF thickness from 89.6 (±16.0) pixels prior to vitrectomy to 71.0 (±37.3) pixels (P = .19, n = 6) post fluid-air exchange (Figure 4).

Boxplot graph of subfoveal fluid post air-fluid exchange stratified by perfluoro-n-octane, drainage retinotomy, and direct drainage from the retinal defect. Inside each box, the central line represents the median and the circles represent the mean. The 25th and the 75th percentile are represented by bottom and top border of the box, respectively. The bottom and the upper whisker represent the minimum and maximum values, respectively.

Figure 1.

Boxplot graph of subfoveal fluid post air-fluid exchange stratified by perfluoro-n-octane, drainage retinotomy, and direct drainage from the retinal defect. Inside each box, the central line represents the median and the circles represent the mean. The 25th and the 75th percentile are represented by bottom and top border of the box, respectively. The bottom and the upper whisker represent the minimum and maximum values, respectively.

Intraoperative optical coherence tomography (iOCT) images of the macula in eyes that underwent vitrectomy with perfluoro-n-octane (PFO) infusion for a macula-off rhegmatogenous retinal detachment (RRD). iOCT images for eyes with a macula-off RRD that had a pars plana vitrectomy with PFO. Images were taken through the fovea just prior to vitrectomy (A, D), post PFO fill (B, E), and after fluid-air exchange. (C, F). Yellow arrowhead indicates subfoveal fluid.

Figure 2.

Intraoperative optical coherence tomography (iOCT) images of the macula in eyes that underwent vitrectomy with perfluoro-n-octane (PFO) infusion for a macula-off rhegmatogenous retinal detachment (RRD). iOCT images for eyes with a macula-off RRD that had a pars plana vitrectomy with PFO. Images were taken through the fovea just prior to vitrectomy (A, D), post PFO fill (B, E), and after fluid-air exchange. (C, F). Yellow arrowhead indicates subfoveal fluid.

Intraoperative optical coherence tomography (iOCT) images of the macula in eyes that had vitrectomy with drainage retinotomy for a macula-off rhegmatogenous retinal detachment (RRD). iOCT images for eyes with a macula-off RRD that had a pars plana vitrectomy with drainage retinotomy. Images were taken through the fovea just prior to vitrectomy (A, C) and after fluid-air exchange (B, D).

Figure 3.

Intraoperative optical coherence tomography (iOCT) images of the macula in eyes that had vitrectomy with drainage retinotomy for a macula-off rhegmatogenous retinal detachment (RRD). iOCT images for eyes with a macula-off RRD that had a pars plana vitrectomy with drainage retinotomy. Images were taken through the fovea just prior to vitrectomy (A, C) and after fluid-air exchange (B, D).

Intraoperative optical coherence tomography (iOCT) images of the macula in eyes that underwent vitrectomy with direct drainage through the primary defect for a macula-off RRD. iOCT images for eyes with a macula-off RRD undergoing pars plana vitrectomy with direct drainage through the primary defect. Images were taken through the fovea just prior to vitrectomy (A, C) and after fluid-air exchange (B, D).

Figure 4.

Intraoperative optical coherence tomography (iOCT) images of the macula in eyes that underwent vitrectomy with direct drainage through the primary defect for a macula-off RRD. iOCT images for eyes with a macula-off RRD undergoing pars plana vitrectomy with direct drainage through the primary defect. Images were taken through the fovea just prior to vitrectomy (A, C) and after fluid-air exchange (B, D).

Visual Acuity Outcomes

There was no significant difference (P = .75) in mean initial logMAR VA between drainage techniques, with a mean initial logMAR VA of 2.21 (± 0.99) (20/3240, Snellen equivalent) in eyes receiving PFO (n = 10), 2.08 (± 0.66) (20/2400, Snellen equivalent) for eyes that underwent a drainage retinotomy (n = 11), and 1.90 (±0.94) (20/1590, Snellen equivalent) for eyes that underwent direct drainage through the primary defect (n = 8).

There was no significant difference (P = .89) in final logMAR between drainage techniques post RRD repair, with a mean logMAR VA of 0.79 (±0.53) (20/120, Snellen equivalent) in eyes receiving PFO (n = 8), 0.74 (±0.63) (20/110, Snellen equivalent) in eyes that underwent drainage retinotomy (n = 10), and 0.90 (±0.81) (20/160, Snellen equivalent) in eyes that had direct drainage through the primary defect (n = 7). There was a significant improvement in logMAR VA from the preoperative visit to the final visit in eyes that had a PFO fill (P = .003), and eyes that underwent a posterior drainage retinotomy (P = .003); however, no significant improvement was observed in eyes that had direct drainage through the retinal break (P = .054). There was a significant decrease in mean logMAR VA for pseudophakic patients, from 1.98 (±1.08) (20/2000, Snellen equivalent) at the initial visit to 0.54 (±0.61) (20/70, Snellen equivalent) at the final visit (P < .001, n = 9). There was a significant decrease in mean logMAR VA for phakic patients, from 2.02 (±0.79) (20/2100, Snellen equivalent) at the initial visit to 0.97 (±0.62) (20/83, Snellen equivalent) at the final visit (P < .001, n = 15).

Functional Outcomes

Postoperatively, there were no significant differences in the proportion of eyes with IRF, persistent SFF, ERM, ellipsoid zone disruption, external limiting membrane disruption, or RPE disruption between the three treatment arms (all P > .1; Table 2). There was a significant difference in mean central subfield thickness between eyes that received PFO (439 [±199]) and eyes that had direct drainage via a retinal break (239, [±34]) (P = .04). There was no significant correlation between SFF thickness post fluid-air exchange and final logMAR VA nor change in logMAR VA after adjusting for initial logMAR VA (P = .83 and P = .95, respectively).

Optical Coherence Tomography Findings of Eyes With a Macula-Off Rhegmatogenous Retinal Detachment After Surgical Repair Stratified by Tamponade Agent Used

Table 2:

Optical Coherence Tomography Findings of Eyes With a Macula-Off Rhegmatogenous Retinal Detachment After Surgical Repair Stratified by Tamponade Agent Used

Discussion

Using iOCT in patients with fovea-involving RRD, this study demonstrated that there is residual SFF present in all cases after fluid-air exchange and there is no significant difference in the amount of residual SFF in eyes repaired with either direct drainage through the primary retinal defect, a posterior retinotomy, or PFO. Indeed, all three techniques appear equally effective at flattening the macula with similar functional and anatomical outcomes. Moreover, despite the potential differences in the nature of the detachment at the start of the case, there was minimal variation in SFF post fluid-air exchange.

One common belief is that use of PFO is more effective at eliminating SRF compared to other drainage techniques. A previous report by Ehlers et al.1 showed retained SRF intraoperatively in all nine eyes receiving PFO. In another study by Toygar et al.,5 six out of nine eyes definitely demonstrated persistent submacular fluid under PFO with all eyes demonstrating increased submacular fluid post fluid-air exchange. Our study demonstrated similar findings with a decrease in SFF while under PFO but an increase after fluid-air exchange. It is likely that the SRF is pushed more anteriorly by the PFO but settles back in the macula even though care is typically taken to drain at the level of the breaks prior to removing the PFO. It was also interesting that draining through the primary retinal defect seemed to yield similar levels of SFF as one might expect more fluid to be trapped posteriorly. However, since our study did not randomize patients to the different drainage techniques, it is possible that surgeons chose to drain through a primary retinal defect only if it was more posteriorly located. In this study, there was no predisposition for any surgeon to use a particular technique. The drainage technique was guided more by the anatomy of the retinal detachment. In particular, the location, size, and number of retinal breaks partially determined the drainage technique.

The relevance of retained SFF on iOCT at the conclusion of retinal detachment repair has yet to be determined. It is known that the retinal pigment epithelium is responsible for fluid egress into the choroid, thus removing any residual SFF post RRD repair. Previous clinical studies have demonstrated that eyes undergoing partial SRF drainage have similar anatomic and functional outcomes to eyes undergoing complete SRF drainage.6 Cohort studies have also shown that SRF height postoperatively is not correlated with final VA, but the presence of SRF postoperatively might appear to be associated with worse early VA outcomes.7,8 However, persistent SRF has been observed to resolve within 12 months postoperatively.8,9 Moreover, excellent anatomic outcomes and functional outcomes have been observed with pneumatic retinopexy, despite retention of SFF after the procedure. Therefore, intraoperative SFF might have a limited role in predicting outcomes post RRD repair.

The results of our regression analysis seem to corroborate these prior studies by suggesting that the degree of intraoperative SFF post air-fluid exchange is not related to final VA outcomes. This holds true even after stratifying by different drainage techniques. Although we did not observe a significant improvement in VA in eyes undergoing direct drainage, we attribute this to either the sample size or baseline logMAR VA as there is no significant difference in final logMAR VA between the three drainage techniques. In addition to the similar functional outcomes, the three drainage techniques also showed similar OCT outcomes at the final visit with no significant difference in the integrity of the outer retinal layers, and presence of IRF. The significant difference in CST may be secondary to outliers, which in a small sample size are more likely to significantly influence comparisons. Given that eyes had no significant difference in baseline characteristics, we believe that there are likely no major differences in functional and anatomic outcomes between the different drainage techniques.

There are several limitations in this study. The small sample size restricts our ability to draw definitive conclusions regarding any relationship between the residual SFF and outcomes. In addition, it is possible that there may be smaller outcome differences between the three drainage techniques that we could not detect. Larger studies will be required to confirm our findings. Another limitation of our study is we did not measure the duration of fluid-air exchange, which may influence the amount of posterior fluid that reaccumulates with PFO use, particularly as the anterior vitreous dehydrates. This series also has a relatively short duration of follow-up postoperatively. A longer follow-up will be required for a more definitive assessment of VA improvement. While best available VA with correction or pinhole was used, manifest refraction would have yielded a more accurate assessment of VA. Another potential limitation is the variance in surgeon technique. This variation in physician preference might be responsible for differences in final SFF thickness, although all surgeons in our practice aim for complete drainage of SFF during macula-off RRD repairs. However, differences in both surgical and drainage technique limit the generalizability of our findings. Larger, multi-physician studies will be required in order to expand on the external validity of our findings.

Using the iOCT during PPV for RRD repair, this study has demonstrated that there is no significant difference in residual SFF regardless of the drainage technique used: direct drainage through the primary retinal defect, drainage through a posterior retinotomy, or use of PFO. Moreover, there appears to be little predictive value in the amount of retained SFF upon functional and anatomical outcomes.

References

  1. Ehlers JP, Ohr MP, Kaiser PK, Srivastava SK. Novel microarchitectural dynamics in rhegmatogenous retinal detachments identified with intraoperative optical coherence tomography. Retina. 2013;33(7):1428–1434. doi:10.1097/IAE.0b013e31828396b7 [CrossRef]
  2. Ray R, Barañano DE, Fortun JA, et al. Intraoperative microscope-mounted spectral domain optical coherence tomography for evaluation of retinal anatomy during macular surgery. Ophthalmology. 2011;118(11):2212–2217. doi:10.1016/j.ophtha.2011.04.012 [CrossRef]
  3. Smith AG, Cost BM, Ehlers JP. Intraoperative OCT-assisted subretinal perfluorocarbon liquid removal in the DISCOVER Study. Ophthalmic Surg Lasers Imaging Retina. 2015;46(9):964–966. doi:10.3928/23258160-20151008-10 [CrossRef]
  4. Ehlers JP, Dupps WJ, Kaiser PK, et al. The Prospective Intraoperative and Perioperative Ophthalmic ImagiNg with Optical CoherEncE TomogRaphy (PIONEER) Study: 2-year results. Am J Ophthalmol. 2014;158(5):999–1007. doi:10.1016/j.ajo.2014.07.034 [CrossRef]
  5. Toygar O, Riemann CD. Intraoperative optical coherence tomography in macula involving rhegmatogenous retinal detachment repair with pars plana vitrectomy and perfluoron. Eye (Lond). 2016;30(1):23–30. doi:10.1038/eye.2015.230 [CrossRef]
  6. Chen X, Zhang Y, Yan Y, et al. Complete subretinal fluid drainage is not necessary during vitrectomy surgery for macula-off rhegmatogenous retinal detachment with peripheral breaks: A prospective, nonrandomized comparative interventional study. Retina. 2017;37(3):487–493. doi:10.1097/IAE.0000000000001180 [CrossRef]
  7. Benson SE, Schlottmann PG, Bunce C, Xing W, Charteris DG. Optical coherence tomography analysis of the macula after scleral buckle surgery for retinal detachment. Ophthalmology. 2007;114(1):108–112. doi:10.1016/j.ophtha.2006.07.022 [CrossRef]
  8. Seo JH, Woo SJ, Park KH, Yu YS, Chung H. Influence of persistent submacular fluid on visual outcome after successful scleral buckle surgery for macula-off retinal detachment. Am J Ophthalmol. 2008;145(5):915–922. doi:10.1016/j.ajo.2008.01.005 [CrossRef]
  9. Karacorlu M, Sayman Muslubas I, Hocaoglu M, Arf S, Ersoz MG. Correlation between morphological changes and functional outcomes of recent-onset macula-off rhegmatogenous retinal detachment: Prognostic factors in rhegmatogenous retinal detachment. Int Ophthalmol. 2018;38(3):1275–1283. doi:10.1007/s10792-017-0591-6 [CrossRef]

Baseline Characteristics of Eyes Undergoing Retinal Detachment Repair Using iOCT Imaging, Mean (± SD) or N (%)

ValuePFODrainage RetinotomyDirect DrainageP Value

Age (Years)63.2 (±11.4)65.3 (±12.7)56.8 (±6.9).22

Number of Tears2.3 (±1.3)2.5 (±1.0)2.7 (±1.2).83

Duration of Symptoms (Days)5.9 (±3.7)4.0 (±1.9)6.8 (±6.6).37

Pseudophakic Eyes4 (40%)5 (41.7%)4 (44.4%).98

Gas Tamponade.26
  SF66 (60.0%)4 (33.3%)6 (66.7%)
  C3F84 (40%)8 (66.7%)3 (33.3%)

Location of Retinal Detachment.99
  Superior5 (50.0%)6 (50.0%)5 (55.6%)
  Inferior1 (10.0%)1 (8.3%)1 (11.1%)
  Total4 (40.0%)5 (41.7%)3 (33.3%)

Type of Surgery.46
  PPV6 (60.0%)10 (83.3%)6 (66.7%)
  PPV + SB4 (40.0%)2 (16.7%)3 (33.3%)

Optical Coherence Tomography Findings of Eyes With a Macula-Off Rhegmatogenous Retinal Detachment After Surgical Repair Stratified by Tamponade Agent Used

ValuePerfluoro-n-octane (n = 6)Drainage Retinotomy (n = 9)Direct Drainage (n = 6)P Value
Intraretinal Cysts3 (50.0%)4 (44.4%)0 (0.0%).12
Subretinal Fluid.24
  No subretinal fluid present4 (66.7%)9 (100.0%)6 (100.0%)
  Subfoveal fluid1 (16.7%)0 (0.0%)0 (0.0%)
  Extrafoveal fluid1 (16.7%)0 (0.0%)0 (0.0%)
Epiretinal Membrane4 (66.7%)5 (55.6%)1 (16.7%).18
Ellipsoid Zone Disruption4 (66.7%)7 (77.8%)4 (66.7%).86
External Limiting Membrane Disruption4 (66.7)7 (77.8%)4 (66.7%).86
Retinal Pigment Epithelium Disruption0 (0.0%)2 (22.2%)0 (0.0%).23
Authors

From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia.

Dr. Hsu has received grants from Roche/Genentech and Santen, as well both grants and personal fees from Ophthotech. Dr. Adam has received grants from Alcon and the Heed Ophthalmic Foundation. Dr. Chiang has received research support/grants from Roche/Genentech and Regeneron. Dr. Klufas has received consulting fees from Allergan, FCI Ophthalmics, and Roche/Genentech. Dr. Ho is a consultant for Allergan, Alcon, and Genentech and has received grants from Allergan, Alcon, Genentech, and Iconic. The remaining authors report no relevant financial disclosures.

Address correspondence to Omesh P. Gupta, MD, The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, 840 Walnut Street, Suite 1020, Philadelphia, PA 19107; email: ogupta@midatlanticretina.com.

Received: July 28, 2018
Accepted: January 17, 2019

10.3928/23258160-20190806-04

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