Macular morphologic changes following successful retinal detachment repair by scleral buckling surgery

Abstract

Background/Aim: Spectral domain optical coherence tomography (SD-OCT) is very useful for accurate examination of macular microstructure. The aim of this study was to evaluate macular morphologic changes after successful retinal detachment (RD) surgery by scleral buckling using SD-OCT and assess their impact on vision repair. Methods: SD-OCT examination was performed 1, 6 and 12 months in 27 eyes following scleral buckling (SB) surgery with successful anatomical repair of rhegmatogenous retinal detachment (RRD) which also affected the macular region. The examination was performed in a 6mm diameter central macular region and included measurements of the central foveal thickness (CFT), average overall retinal thickness and thickness of the outer and inner retinal layers separately. The numerical values of operated eyes were compared with those of the fellow (control) eyes. The condition of the outer limiting membrane (ELM) and inner segment/outer segment of the photoreceptors (IS/OS) was also examined. Results: The mean total and outer retinal thickness (TRT and ORT) in the reattached regions in the operated eyes were significantly thinner than the corresponding regions of the fellow (control) eye, and throughout the follow-up period the difference was statistically significant. There was a statistically significant difference in TRT (after 1 month p=0.021, after 6 months p=0.026, after 12 months p=0.027) and ORT (after 1 month p=0.018, after 6 months p=0.019, after 12 months p=0.021) between the eyes with a longer pre-operative duration of macular detachment of 2 weeks and eyes with shorter detachment period. Disruptions of the photoreceptors IS/OS and ELM on OCT examination after one month were observed in 37.04% eyes, after 6 months in 29.6% eyes, and at the end of the follow-up period in 14.8% eyes. A statistically significant difference was found in the frequency of disruptions of the IS/OS and ELM depending on the preoperative duration of RD (p= 0.007). Conclusion: Overall decrease in the mean retinal thickness after successful anatomical repair of RD is result of decreases in the thicknesses of outer retinal layers. The alterations of the external limiting membrane and inner and outer photoreceptors segments observed on the early SD-OCT scans are mostly associated with limited visual recovery. The prolonged macular detachment leads to damage to the neurosensory tissue of the retina and especially the photoreceptors, which may explain the limited visual recovery after successful scleral buckling RD repair.