MACULAR STRUCTURE AND FUNCTION IN RETINAL DETACHMENT COMPLICATED BY PROLIFERATIVE VITREORETINOPATHY
In brief
Macular edema affects 63% of eyes one year after complex detachment surgery
In 139 eyes operated on for retinal detachment complicated by scarring, cystoid macular edema rose from 21% at 10 days to 63% at 12 months, while epiretinal membrane affected half of eyes. Vision improved early but changed little afterward; severe retinal disruption on a 10-day scan was independently associated with poorer vision at one year, though the study's prognostic model had only moderate accuracy.
- Journal
- Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde (Q1)
- Published
- 27 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Rodrigo Anguita, Peng Yong Sim, Lorenzo Ferro Desideri, Moritz Joachim Schmid, Philip J Banerjee, Martin Zinkernagel, et al.
- PMID
- 42945440
- DOI
- 10.1159/oph/aeeag019
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 29 October 2026): Retinal detachment surgery outcomes and OCT visual predictors
Abstract
INTRODUCTION: Macular structural changes after surgery for rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR) remain poorly characterised. The aim of this study was to evaluate longitudinal macular structural changes on optical coherence tomography (OCT) and their relationship to visual function over 12 months in eyes undergoing pars plana vitrectomy (PPV) with silicone oil tamponade for PVR-related RRD. METHODS: Post-hoc analysis from a phase IIIb, single-centre, participant-masked, prospective, randomised controlled trial of slow-release dexamethasone in PVR-related RRD conducted at Moorfields Eye Hospital. One hundred and thirty-nine (139) eyes of 139 patients undergoing PPV with silicone oil tamponade for RRD with confirmed PVR-C were included. Spectral-domain OCT imaging and best-corrected visual acuity (BCVA, LogMAR) were obtained preoperatively and at 10 days, 6 months, and 12 months postoperatively. Retinal-layer thicknesses were obtained by manual segmentation and 13 qualitative biomarkers were graded. Univariable regression and Firth penalised multivariable logistic regression were used to identify early structural predictors of 12-month BCVA. RESULTS: Central retinal thickness (CRT) increased significantly from 314.9 µm at 10 days to 370.9 µm at 12 months (p < 0.0001). The outer plexiform layer and outer nuclear layer showed dynamic changes over time. The proportion of eyes with epiretinal membrane (ERM) rose from 22.1% at 10 days to 41.2% at 6 months (p=0.001) and 49.6% at 12 months (p=0.011 versus 6 months), and cystoid macular oedema (CMO) increased from 20.7% to 52.2% (p<0.0001) and 62.6% (p = 0.029). Mean BCVA improved from 1.68 LogMAR preoperatively to 1.06 LogMAR at 10 days (p < 0.0001), with no significant further change to 0.92 LogMAR at 12 months. In univariable analysis, retinal pigment epithelium (RPE) thickness, outer retinal layer thickness, gross full-thickness retinal disruption, disrupted ellipsoid and external limiting membrane, absence of a foveal bulge, subretinal PVR and persistent subretinal macular fluid at 10 days were associated with poorer 12-month BCVA (all p < 0.05). In the multivariable model, 10-day BCVA (adjusted odds ratio [aOR] 3.52, 95% CI 1.31-11.2) and gross full-thickness retinal disruption (aOR 10.51, 95% CI 1.16-1391) remained independently associated with moderate visual impairment at 12 months (BCVA worse than 6/38; LogMAR > 0.80), with an area under the receiver operating characteristic curve of 0.71. CONCLUSIONS: Macular structural changes after surgery for PVR-related RRD reflect extensive cellular remodelling with progressive development of ERM and CMO. Early (10-day) postoperative OCT findings are associated with 12-month visual outcome and may help inform prognosis in PVR-related RRD.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.