Ocular coherence tomographic examination of postoperative foveal architecture after scleral buckling vs vitrectomy for macular off retinal detachment

Aims This pilot study uses Optical Coherence Tomography (OCT) imaging to compare the difference in foveal architecture after successful retinal detachment (RD) surgery by scleral buckling or pars plana vitrectomy (PPV). Methods Prospective recruitment of patients with macular off RDs. Detachment surgery was undertaken by scleral buckling, external drainage, and air injection (group 1) or by PPV (group 2). Postoperatively patients had clinical examinations and OCT at 1, 3, 6, and 12 months. If abnormalities persisted, a further OCT was obtained at 18 months. Results Retinal reattachment, including clinical macular reattachment, was achieved in all cases within 24 h postoperatively. In group 1 ( n =22), postoperative OCT showed persistent foveal detachment in 63% of cases ( n =14) at 1 and 3 months. At 6 and 12 months, 36% ( n =8) and 9% ( n =2) had a persistent foveal detachment, respectively, and at 18 months, foveal detachment eventually. In group 2 ( n =21), postoperative OCT showed an attached fovea in all cases; however, foveal thickening suggesting intraretinal oedema was present in all cases. The oedematous appearance of retina on OCT settled in 1–3 months. No foveal abnormality was seen at 6 and 12 months postoperatively. Conclusions A high proportion of patients with successful retinal reattachment surgery by scleral buckling had foveal detachments postoperatively. No cases who had PPV had foveal detachments; however, transient retinal oedema was evident in all cases. The aetiology of these changes is unknown and warrants further investigation, as there is the potential of a long-term effect on vision.