Background.The term retinal detachment is used to describe a separation of the neurosensory retina from the retinal pigment epithelium (RPE). When the normal physiologic forces that maintain contact between the retina and the RPE (e.g., the metabolic pump of the RPE, the osmotic pressure of the choroid, and the more minor mechanical forces of the interphotoreceptor matrix) are compromised or overwhelmed, a retinal detachment occurs. Various pathologic conditions can upset the balance of the normal transretinal pressure gradient and result in subretinal fluid accumulation.
Purpose. Scleral buckling surgery and pars plana vitrectomy are competing methods in the treatment of retinal detachment. The recent development of spectral-domain optical coherence tomography (SD-OCT) has dramatically improved the visualization of retinal layer relative to conventional OCT, and offers new opportunities to investigate the discordances between anatomic and functional outcomes after retinal detachment surgery. Hence, the study aim is to use SD-OCT to compare the evaluation of Retinal Nerve Fiber Layer(RNFL), ganglion cell layer(GCL) and inner plexiform layer(IPL) between scleral buckling and vitrectomy for macular-off rhegmatogenous retinal detachment.
Methods. In this retrospective observational case series, we will evaluate all the patients who underwent scleral buckling surgery (group 1) and all the patients who underwent pars plana vitrectomy (group 2) as the primary surgery for macula-off rhegmatogenous retinal detachment. Spectral Domain Optical coherence Tomography(SD-OCT) was used to measure the retinal layers.
Results.SD-OCT measurements were obtained 3 and 12¿months after the operation. All patients underwent pre- and postoperative best-corrected Visual Acuity (VA) testing [converted to the logarithm of the minimal angle of resolution (logMAR)], slit-lamp biomicroscopy, and dilated fundus examination.
Some studies have been demostrated that a quickly surgery could ensured better conversation of retinal layers. Currently research is concentrated on the inner retinal layers.(1,2)
The research aims to evaluate the RFNL, GCL and IPL retinal layers, after succesful surgery in DR-macula off patients, in order to understand the possible alterations o these layers. The research want to compare the difference between the Scleral buckling and pars plana vitrectomy.
Damage suffered by these layers is still poorly evaluated and it could lead to explain the incomplete visual recovery of some patients.Furthemore, the growing understanding of the damage mechanism to the retinal layers after DR, it may lead to better patient management, and improving clinical outcomes and quality life.
To summarize, our results should have an important impact on clinical knowledge and could be used as a potential biomarker to predict recovery after treatments, so as to identify new neuroprotective therapies that will always provide great benefits
Retinal layer measurements after successful macula-off retinal detachment repair using optical coherence tomography.Menke MN, Kowal JH, Dufour P, Wolf-Schnurrbusch UE, Ceklic L, Framme C, Wolf S. Invest Ophthalmol Vis Sci. 2014 Sep 4;55(10):6575-9. doi: 10.1167/iovs.14-14412
Inner and outer central retinal findings after surgery for rhegmatogenous retinal detachmentusing different spectral-domain optical coherence tomography devices.Matlach J, Pflüger B, Hain J, Göbel W.Graefes ,Arch Clin Exp Ophthalmol. 2015 Mar;253(3):369-80. doi: 10.1007/s00417-014-2713-4. Epub 2014 Jul 17.