Clinical outcomes of complete or partial subretinal fluid drainage for macula-off rhegmatogenous retinal detachment with peripheral breaks_Chinese Journal of Ocular Fundus Diseases

Authors：

YanYing ,  ChenXiao , HongLing , ZhuLi , DengJun , ZengMiao , SongYanping

Department of Ophthalmology, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China;

Corresponding author：

ChenXiao, Email: cxnf@163.com

Keywords：

Retinal detachment/surgery; Retinal perforations/surgery; Vitreoretinal surgery; Subretinal fluid

DOI：

10.3760/cma.j.issn.1005-1015.2016.05.010

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Objective To compare clinical outcomes in eyes with macula-off rhegmatogenous retinal detachments (RRD) with peripheral breaks managed by surgical protocols that result in either complete (CSFD) or partial subretinal fluid drainage (PSFD). Methods Following the clinical detection of a macula-off RRD with peripheral retinal breaks, patients were offered the opportunity to enroll in the study, and those patients who signed the consent were evaluated for eligibility based upon the inclusion and exclusion criteria for this clinical study, and if fully eligible they were assigned prospectively to one of the two surgical designs (PSFD or CSFD, 1:1) using a random number table. Seventy-two eyes of 72 patients were enrolled and studied. Patients were treated with 25G plus vitrectomy, endolaser or transscleral cryopexy, either complete (n=36), or partial (n=36) subretinal fluid drainage, and 14%C₃F₈ (PFO) was used for intraocular tamponade. After surgery, all patients were kept in a supine position for 24 hours, and then in a clinically optimal position for 6-10 days. The study patients were examined at 1, 3 and 6 months after surgery with thorough ophthalmic examinations. Macular optical coherence tomography (OCT) imaging was acquired in 1 month. Anatomical and visual outcomes as well as intra-operative and postoperative complications of the two groups were compared. Furthermore, the persistence of subfoveal fluid in OCT images and the symptoms of distortion at 3 months were measured and recorded. The primary study endpoint of anatomic retinal reattachment for each group was based upon the 6-month time-point. Results The preoperative baseline characteristics between the two groups were not significantly different. The single-operation success rates were 88.9% and 91.6% respectively for the CSFD and the PSFD groups (χ²=0.158, P>0.05). The mean best corrected visual acuity (BCVA) at 6 month endpoint were 0.99±0.52 minimum resoluation angle in logarithmic (logMAR) for the CSFD group and 1.07±0.34 logMAR for the PSFD group(t=0.580,P=0.564). The mean operative time was longer in the CSFD group (62.25±4.32) minutes than that in the PSFD group (47.9±5.0) minutes (t=0.580, P=0.564). seven of 29 (24.1%) phakic eyes in the CSFD group had lens injury during SRF drainage, and none of the 31-phakic eyes in the PSFD group sustained lens damage. Residual PFO was present in 6 of 36 CSFD cases (16.7%). Successful retinal reattachment after primary surgery was achieved in 33) PSFD eyes and in 32 CSFD eyes based upon OCT imaging at 1 month demonstrated reattached foveae with no residual subfoveal fluid. Among these patients, 22 patients (62.5%) in the CSFD group and 23(69.7%) patients in the PSFD group reported distortion in the operated eye or/and a difference in image size between the two eyes at the 6 month visit (P=1.00). Conclusions Partial subretinal fluid drainage during pars plana vitrectomy for the repair of macula-off RRD with peripheral breaks is effective. The success rates are not statistically different. Additionally, PSFD procedures can simplify the surgery procedure, shorten operative time and, and to some extent, reduce the incidence of complications relevant to the CSFD approach.

Citation： YanYing, ChenXiao, HongLing, ZhuLi, DengJun, ZengMiao, SongYanping. Clinical outcomes of complete or partial subretinal fluid drainage for macula-off rhegmatogenous retinal detachment with peripheral breaks. Chinese Journal of Ocular Fundus Diseases, 2016, 32(5): 500-504. doi: 10.3760/cma.j.issn.1005-1015.2016.05.010 Copy

1.	Sonoda Y, Yamakiri K, Sonoda S,et al.Endoscopy-guided subretinal fluid drainage in vitrectomy for retinal detachment[J]. Ophthalmologica,2006,220(2):83-86.
2.	Tan HS,Oberstein SY, Mura M,et al.Air versus gas tamponade in retinal detachment surgery[J].Br J Ophthalmol,2013,97(1):80-82.DOI:10.1136/bjophthalmol-2012-302140.
3.	Doft BH.Intentional retinotomy for internal drainage of subretinal fluid[J]. Arch Ophthalmol,1986,104(6):807-808.
4.	Garcia-Valenzuela E, Ito Y, Abrams GW.Risk factors for retention of subretinal perfluorocarbon liquid in vitreoretinal surgery[J]. Retina,2004,24(5):746-752.
5.	McDonald HR, Lewis H, Aaberg TM,et al.Complications of endodrainage retinotomies created during vitreous surgery for complicated retinal detachment[J]. Ophthalmology,1989, 96(3):358-363.
6.	Tewari A, Eliott D, Singh CN,et al.Changes in retinal sensitivity from retained subretinal perfluorocarbon liquid[J].Retina,2009,29(2):248-250. DOI:10.1097/IAE.0b013e318188c7ea.
7.	Lesnoni G, Rossi T, Gelso A.Subfoveal liquid perfluorocarbon[J].Retina,2004, 24(1):172-176.
8.	Chen X, Yan Y, Hong L, et al.A comparison of strict face-down positioning with adjustable positioning after pars plana vitrectomy and gas tamponade for rhegmatogenous retinal detachment[J].Retina,2015,35(5):892-898. DOI:10.1097/IAE.0000000000000413.
9.	Sasoh M.The frequency of subretinal fluid drainage and the reattachment rate in retinal detachment surgery[J].Retina,1992,12(12):113-117.
10.	Salicone A, Smiddy WE, Venkatraman A,et al.Visual recovery after scleral buckling procedure for retinal detachment[J].Ophthalmology,2006,113(10):1734-1742.
11.	Quintyn JC, Brasseur G.Subretinal fluid in primary rhegmatogenous retinal detachment:physiopathology and composition[J].Surv Ophthalmol,2004,49(1):96-108.
12.	Wolfensberger TJ, Gonvers M.Optical coherence tomography in the evaluation of incomplete visual acuity recovery after macula-off retinal detachments[J]. Graefe's Arch Clin Exp Ophthalmol,2002,240(2):85-89.
13.	Wolfensberger TJ.Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery[J]. Ophthalmology,2004, 111(7):1340-1343.
14.	Benson SE, Schlottmann PG, Bunce C,et al.Optical coherence tomography analysis of the macula after vitrectomy surgery for retinal detachment[J].Ophthalmology, 2006,113(7):1179-1183.
15.	Benson SE, Schlottmann PG, Bunce C,et al.Optical coherence tomography analysis of the macula after scleral buckle surgery for retinal detachment[J].Ophthalmology, 2007,114(1):108-112.
16.	Veckeneer M, Derycke L, Lindstedt EW, et al.Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment:hypothesis and review[J].Graefe´s Arch Clin Exp Ophthalmol,2012, 250(6):795-802. DOI:10.1007/s00417-011-1870-y.
17.	Ehlers JP, Ohr MP, Kaiser PK,et al.Novel microarchitectural dynamics in rhegmatogenous retinal detachments identified with intraoperative optical coherence tomography[J].Retina,2013,33(7):1428-1434. DOI:10.1097/IAE.0b013e31828396b7.
18.	Ehlers JP, Tam T, Kaiser PK,et al.Utility of intraoperative optical coherence tomography during vitrectomy surgery for vitreomacular traction syndrome[J]. Retina, 2014,34(7):1341-1346. DOI:10.1097/IAE.0000000000000123.
19.	Ehlers JP, Itoh Y, Xu LT,et al.Factors associated with persistent subfoveal fluid and complete macular hole closure in the PIONEER study[J].Invest Ophthalmol Vis Sci,2014,56(2):1141-1146. DOI:10.1167/iovs.14-15765.

1. Sonoda Y, Yamakiri K, Sonoda S,et al.Endoscopy-guided subretinal fluid drainage in vitrectomy for retinal detachment[J]. Ophthalmologica,2006,220(2):83-86.
2. Tan HS,Oberstein SY, Mura M,et al.Air versus gas tamponade in retinal detachment surgery[J].Br J Ophthalmol,2013,97(1):80-82.DOI:10.1136/bjophthalmol-2012-302140.
3. Doft BH.Intentional retinotomy for internal drainage of subretinal fluid[J]. Arch Ophthalmol,1986,104(6):807-808.
4. Garcia-Valenzuela E, Ito Y, Abrams GW.Risk factors for retention of subretinal perfluorocarbon liquid in vitreoretinal surgery[J]. Retina,2004,24(5):746-752.
5. McDonald HR, Lewis H, Aaberg TM,et al.Complications of endodrainage retinotomies created during vitreous surgery for complicated retinal detachment[J]. Ophthalmology,1989, 96(3):358-363.
6. Tewari A, Eliott D, Singh CN,et al.Changes in retinal sensitivity from retained subretinal perfluorocarbon liquid[J].Retina,2009,29(2):248-250. DOI:10.1097/IAE.0b013e318188c7ea.
7. Lesnoni G, Rossi T, Gelso A.Subfoveal liquid perfluorocarbon[J].Retina,2004, 24(1):172-176.
8. Chen X, Yan Y, Hong L, et al.A comparison of strict face-down positioning with adjustable positioning after pars plana vitrectomy and gas tamponade for rhegmatogenous retinal detachment[J].Retina,2015,35(5):892-898. DOI:10.1097/IAE.0000000000000413.
9. Sasoh M.The frequency of subretinal fluid drainage and the reattachment rate in retinal detachment surgery[J].Retina,1992,12(12):113-117.
10. Salicone A, Smiddy WE, Venkatraman A,et al.Visual recovery after scleral buckling procedure for retinal detachment[J].Ophthalmology,2006,113(10):1734-1742.
11. Quintyn JC, Brasseur G.Subretinal fluid in primary rhegmatogenous retinal detachment:physiopathology and composition[J].Surv Ophthalmol,2004,49(1):96-108.
12. Wolfensberger TJ, Gonvers M.Optical coherence tomography in the evaluation of incomplete visual acuity recovery after macula-off retinal detachments[J]. Graefe's Arch Clin Exp Ophthalmol,2002,240(2):85-89.
13. Wolfensberger TJ.Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery[J]. Ophthalmology,2004, 111(7):1340-1343.
14. Benson SE, Schlottmann PG, Bunce C,et al.Optical coherence tomography analysis of the macula after vitrectomy surgery for retinal detachment[J].Ophthalmology, 2006,113(7):1179-1183.
15. Benson SE, Schlottmann PG, Bunce C,et al.Optical coherence tomography analysis of the macula after scleral buckle surgery for retinal detachment[J].Ophthalmology, 2007,114(1):108-112.
16. Veckeneer M, Derycke L, Lindstedt EW, et al.Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment:hypothesis and review[J].Graefe´s Arch Clin Exp Ophthalmol,2012, 250(6):795-802. DOI:10.1007/s00417-011-1870-y.
17. Ehlers JP, Ohr MP, Kaiser PK,et al.Novel microarchitectural dynamics in rhegmatogenous retinal detachments identified with intraoperative optical coherence tomography[J].Retina,2013,33(7):1428-1434. DOI:10.1097/IAE.0b013e31828396b7.
18. Ehlers JP, Tam T, Kaiser PK,et al.Utility of intraoperative optical coherence tomography during vitrectomy surgery for vitreomacular traction syndrome[J]. Retina, 2014,34(7):1341-1346. DOI:10.1097/IAE.0000000000000123.
19. Ehlers JP, Itoh Y, Xu LT,et al.Factors associated with persistent subfoveal fluid and complete macular hole closure in the PIONEER study[J].Invest Ophthalmol Vis Sci,2014,56(2):1141-1146. DOI:10.1167/iovs.14-15765.

Chinese Journal of Ocular Fundus Diseases

Clinical outcomes of complete or partial subretinal fluid drainage for macula-off rhegmatogenous retinal detachment with peripheral breaks

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