Session Title: FP-16 Vitreoretinal Surgery IV
Session Date/Time: Sunday 14/09/2014 | 11:00-13:00
Paper Time: 12:12
Venue: Boulevard D
First Author: : J.Tee UK
Co Author(s): : A. Laidlaw
To obtain a better understanding of the prevalence and natural history of subfoveal blebs following surgery for macular off detachments.
Macular off retinal detachment cases that were operated on at St Thomas’ Hospital London between 2009- early 2013.
Retrospective study. A search through surgical (VITREOR) database was conducted to search for cases that fit criteria as set out below, and those cases with OCTs were further analysed. There were 90 cases in total split between 2 groups, ie Group A and Group B. Group A comprised of macular off detachments resulting from posterior vitreous detachment (PVD) related horseshoe tears that were successfully reattached with a single vitrectomy & gas procedure. Cases that required more than one operation to reattach retina were not included in the study. Group B comprised of macular off detachments resulting from round holes or dialyses, the majority of which did not have a PVD, and were treated with scleral buckling and cryotherapy procedure. Cases that required more than one operation to reattach retina were not included in the study.
There were 50 patients in Group A. All resulted from PVD related horseshoe tears, and all were treated with vitrectomy & gas. Median VA at presentation was CF. Median symptom duration 6 days (range 0-120 days). 21 patients had OCT performed by the 8th postoperative week, of which 3 demonstrated persistent subfoveal fluid (14%). 20 patients had OCT done between 5-7 months post-operative, only 1 patient had persistent subfoveal fluid (5%). From Kaplan Meier graph, 22% with persistent fluid at 120 days, decreasing to 8% with persistent fluid at 1 year. There were 40 patients in Group B. 25 with round holes, 12 with dialysis. 31 patients without PVDs, 5 with PVDs. Remainder unspecified. 35 cases treated with scleral buckling, 5 with vitrectomy &gas. Median VA on presentation was 6/24. Median symptom duration 14 days (1 – 180 days) 28 patients had OCT by 8th post-operative week, of which 23 demonstrated subfoveal fluid (82%). 15 patients had OCT between 5-7 months post op, 10 with subfoveal fluid(67%). From the Kaplan Meier graph, 75% with persistent fluid at 120 days, 34% with persistent fluid at 1 year.
Persistent subfoveal fluid is more common in Group B patients with round hole and dialysis related retinal detachments. This may be due to the chronicity of these detachments that can result in subretinal fluid with higher viscosity and cellularity persisting for a longer period. Future treatment options could be geared towards removing this fluid at time of surgery to provide a better outcome.