Comparison between refractive outcomes between macula-on and macula-off retinal detachments after phaco-vitrectomy

Area of Science:

• Ophthalmology
• Retinal Surgery
• Ophthalmic Measurements

Background:

• Rhegmatogenous retinal detachment (RRD) with macular involvement requires surgical intervention.
• Combined vitrectomy and cataract surgery is a common treatment for RRD.
• Accurate axial length (AL) measurement is crucial for predictable refractive outcomes after cataract surgery.

Purpose of the Study:

• To evaluate the accuracy of axial length (AL) measurements using A-scan ultrasonography.
• To assess refractive outcomes after combined vitrectomy and cataract surgery in patients with RRD.
• To compare refractive shifts in eyes with attached versus wholly detached macula.

Main Methods:

• Retrospective, comparative clinical study.
• Patients undergoing vitrectomy and cataract surgery for RRD were divided into attached (n=31) and detached macula (n=33) groups.
• Eyes with measurable AL similar to the fellow eye in the detached group (n=20) were compared to the attached group.

Main Results:

• A-scan AL measurements were accurate in the attached macula group, with a refractive shift (RS) of -0.57 D.
• In the detached macula group, AL was measurable similar to the fellow eye in 60.6% of cases, with an RS of -0.09 D.
• A difference in AL measurement, potentially due to sub-retinal fluid, correlated with a significant refractive shift difference (0.48 D, P=0.025).

Conclusions:

• When axial length can be accurately measured in RRD with a wholly detached macula, refractive shifts are comparable to those with an attached macula after phacovitrectomy.
• In cases of wholly detached macula, axial length may be measured from the retinal pigment epithelium (RPE) beneath the detached retina.
• Accurate AL measurement is critical for achieving desired refractive outcomes in complex RRD cases.