RNFL damage after treatment for retinal detachment

Changes in circumpapillary retinal nerve fiber layer thickness after vitrectomy for rhegmatogenous retinal detachment

The study aimed to evaluate the long-term changes in circumpapillary retinal nerve fiber layer (RNFL) thickness after vitrectomy for rhegmatogenous retinal detachment (RRD) repair. A total of 33 eyes of 33 patients were enrolled. By using optical coherence tomography, the circumpapillary RNFL thickness was measured before surgery and 1, 3, 6 months and 1, 2, 3 years after surgery and compared with the preoperative value. The effect of duration, location, and extent of RRD on RNFL thickness change was evaluated. There was a significant increase of circumpapillary RNFL thickness at the 1-month, 3-month [except in the nasal superior sector (P = 0.627)], and only in the nasal inferior sector at 6-month (P = 0.010) follow-up compared with the baseline value (all Ps < 0.05). No significant differences were observed 1, 2, and 3 years after the surgery (P > 0.05). The duration, location, and extent of detachment did not reveal significant correlations with RNFL parameters (P > 0.05). Circumpapillary RNFL thickness in eyes with RRD after vitrectomy demonstrated a transient increase during the early postoperative period. This increase was not associated with duration, location, and extent of RRD. At 3 years following surgery, no RNFL thinning or thickening was observed.

Scleral Buckling versus Vitrectomy for Retinal Detachment Repair: Comparison of Visual Fields and Nerve Fiber Layer Thickness

PURPOSE

To compare visual field loss and retinal nerve fiber layer (RNFL) defects in cases of rhegmatogenous retinal detachment (RRD) treated with scleral buckle (SB) versus pars plana vitrectomy (PPV) and C3F8 injection.

METHODS

This was a prospective, comparative interventional study of 50 eyes with primary RRD, treated with PPV (25 eyes) or SB (25 eyes). All measurements took place at least 9 months following successful and uncomplicated surgical treatment. The visual field total deviation (TD) values for preoperative attached and detached areas were calculated and compared separately. The optic nerve head morphology was studied with Heidelberg retinal tomography (HRT), and the RNFL using spectral-domain optical coherence tomography.

RESULTS

The preoperative detached areas demonstrated more affected TD values (in dB) compared to the preoperative attached areas (-6.9 ± 5.2 vs. -4.3 ± 3.3 for the SB group and -9.6 ± 5.2 vs. -7.8 ± 5.1 for the PPV group; p = 0.001) in both groups. The preoperative attached areas of the SB group showed better TD values (calculated mean values) compared to the preoperative attached areas of the PPV group (-4.3 ± 3.3 vs. -7.8 ± 5.1, p = 0.007). The RNFL and HRT values showed no statistically significant difference between the two groups.

CONCLUSIONS

It seems that the preoperative detached retina, despite successful reattachment, suffers permanent damage as a result of the detachment, irrespective of the method of treatment. In the PPV group, the postoperative functionality of the preoperative attached areas was detected to be worse compared to the postoperative functionality of the preoperative attached areas of the SB group. We postulate that this fact could be attributed to an additional traumatizing factor (possibly fluid-air exchange or gas injection) in patients with RRD treated with PPV.