Photoreceptor disruption related to persistent submacular fluid after successful scleral buckle surgery

To investigate serial changes in photoreceptor status and associated visual outcome in patients with persistent submacular fluid after successful scleral buckle surgery for macula-off rhegmatogenous retinal detachment.

This was a prospective observational case series including 76 consecutive patients who underwent successful scleral buckle surgery for macula-off rhegmatogenous retinal detachment with symptom duration ≤90 days at a single tertiary hospital. Optical coherence tomography (OCT) and visual acuity examination were performed at one month and three months postoperatively and at three-month intervals until the submacular fluid disappeared. Main outcome measures were postoperative photoreceptor status on OCT and visual acuity.

Forty-two patients (55.3%) showed persistent submacular fluid at postoperative one month. Of 42 patients with persistent submacular fluid, three (7.1%) showed photoreceptor disruption on OCT. None of the 34 patients without persistent submacular fluid showed photoreceptor disruption. Two patients (4.8%) had progressive photoreceptor disruption, and one patient (2.4%) had early photoreceptor disruption. All three patients showed photoreceptor reappearance and limited visual restoration after absorption of submacular fluid. Final visual acuities were significantly worse in these three patients (20 / 1000, 20 / 133, and 20 / 133) compared to those of the other patients (mean, 20 / 30) with persistent submacular fluid and intact photoreceptors.

Even after successful scleral buckle surgery for rhegmatogenous retinal detachment, photoreceptor disruption can occur related to persistent submacular fluid and may be a cause of poor visual outcome.