Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery.
OBJECTIVE
To investigate the time course of foveal reattachment after successful surgery for macula-off retinal detachments.


METHODS
Prospective comparative nonrandomized interventional trial.


METHODS
Thirty-three patients (16 female and 17 male, 65+/-3 years old) with a spontaneous rhegmatogenous retinal detachment with peripheral breaks and a shallow elevation of the fovea.


METHODS
Nine patients were treated with episcleral buckle, cryotherapy, and, in selected cases, external drainage of subretinal fluid. Twenty-four patients were treated with vitrectomy, cryotherapy, and either complete (n = 8), or partial (n = 16) fluid-gas exchange. Patients with complete fluid-gas exchange were kept first in a prone position for 6 hours to help evacuation of subretinal fluid and, afterwards, on their side. Patients with partial fluid-gas exchange were kept in a supine position with the head elevated for 12 hours, allowing spontaneous absorption of submacular fluid. Patients were examined at 1, 6, and 10 to 12 months after surgery with a complete ophthalmic examination as well as optical coherence tomography (OCT). Mean follow-up was 10.0+/-0.5 months.


METHODS
Foveal attachment was determined clinically and by OCT.


RESULTS
Postoperative OCT examination 1 month after buckle surgery (n = 9) showed a small subclinical area of subfoveal fluid in 67% of patients (n = 6). Fluid was still present in 45% of cases (n = 4) at 6 months and in 11% of cases (n = 1) even at 12 months. Optical coherence tomography examination 1 month after vitrectomy showed a completely attached fovea with no subfoveal fluid in all cases (n = 24).


CONCLUSIONS
Complete foveal reattachment after macula-off retinal detachment occurs without delay after vitrectomy, whereas subfoveal fluid may persist subclinically for several months in patients operated with a buckle.
Wolfensberger
Thomas J
TJ
Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland. thomas.wolfensberger@ophtal.vd.ch
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017679:Cryotherapy / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D005584:Fovea Centralis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D011446:Prospective Studies; D012163:Retinal Detachment / Q000175:diagnosis / Q000601:surgery*; D012591:Scleral Buckling / Q000379:methods*; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D016683:Supine Position; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014821:Vitrectomy / Q000379:methods*
D013459:Sulfur Hexafluoride