Study Finds effect of RRD on retinal sensitivity assessed by MP and microvascular network evaluated using OCTA
Retinal detachment (RD) is defined as detachment of the neurosensory retina from the underlying retinal pigment epithelium (RPE). It is commonly known that primary rhegmatogenous RD (RRD) might be successfully managed with various surgical interventions, especially scleral buckling (SB), and both pars plana vitrectomy (PPV) and combined phacoemulsification with vitrectomy (phaco-PPV). The choice of surgery method and its specific modifications vary significantly between surgeons and centers, partly due to the fact that there is still no strong certainty evidence of significant differences in both the structural and functional outcome between these major RRD management procedures.
The comparative efficacy of SB and PPV has been widely studied using major endpoints, including the final best corrected visual acuity (BCVA), reattachment rates, and the occurrence of adverse effects. Interestingly, some recent studies have indicated that preoperative and postoperative foveal and perifoveal retinal sensitivity assessed using the microperimetry (MP) technique might also be a crucial factor in comparing the effectiveness of retinal surgeries. Moreover, the optical coherence tomography angiography (OCTA) technique has been demonstrated to be an essential comparative point for assessing both pre- and postoperative macular microcirculation and vessel density (VD) with good reproducibility and repeatability.
The aim of this study was to compare the retinal changes in function, structure, and microvascular network assessed by MP, spectral domain OCT (SD-OCT), and OCTA between eyes after phaco-PPV and SB operations for macula-on RRD and unaffected fellow eyes. In addition, the correlations of the retinal structural changes assessed with both OCTA and SD-OCTA with the retinal sensitivity analyzed with MP and BCVA tests were determined. Authors hypothesized that significant disturbances in the microvascular network may occur in eyes after SB, which may result in impaired retinal function.
This cross-sectional study included patients who underwent anatomically successful repair of macula-on RRD managed with SB (n=35) and phaco-PPV (n=35) between 2019–2023. All participants were examined within 6–20 months of surgery to evaluate the retinal structure using spectral domain optical coherence tomography (SD-OCT) and vessel density (VD) by OCT angiography (OCTA). Best-corrected visual acuity (BCVA) and microperimetry (MP) tests were used to assess the retinal function.
Analysis of the microvascular network with OCTA between eyes after surgery and healthy eyes showed a decrease in VD. Significant changes in the superficial vascular plexus (SVP) and deep vascular plexus (DVP) were observed only in eyes after SB surgery (p <0.001 and p=0.02, respectively). Analysis of retinal function assessed by MP showed a significant decrease (p><0.05) in retinal sensitivity after phaco-PPV (24.81±2.25 dB) and SB (24.18±2.14 dB) operations compared to the healthy control group (25.97 ± 1.51 dB), whereas postoperative BCVA showed no differences (p>0.05).
In this retrospective study, authors found an effect of RRD, even when the macula was not involved, on retinal sensitivity assessed by MP and the microvascular network evaluated using OCTA. The decrease in retinal AT was more significant in eyes undergoing SB surgery than in eyes undergoing phaco-PPV, similar to the reduction in VD. In addition, study showed statistically significant but weak association between the reduction of VD in the SVP and RPC and decreased AT of the retina in the eyes after SB surgery.
In conclusion, study found that even after successful repair surgery for macula-on RRD, there is a crucial change in retinal function that can be accurately assessed using the MP. Changes in AT of retinal sensitivity were associated with loss of the microvascular network on OCTA examination. Authors believe that the decrease in AT sensitivity of the retina may be mediated by the reduction in VD, and that these changes are more significant in eyes following SB surgery than in eyes after phaco-PPV. SB surgery may result in reduced vascular perfusion possibly secondary to mechanical stress.
Source: Zabel et al; Clinical Ophthalmology 2024:18https://doi.org/10.2147/OPTH.S480833
