Prevalence and predictors of metamorphopsia after successful vitrectomy surgery for macula-off rhegmatogenous retinal...

To estimate metamorphopsia prevalence, predictors and etiologies in patients operated for rhegmatogenous retinal detachment (RRD) with detached macula with successful results.

Retrospective study including 50 eyes of 50 patients who underwent pars plana vitrectomy for RRD with detached macula with standard silicone oil (SO) tamponade. Patients who had successful surgery with durable anatomic reapplication of the retina after SO removal were included. Patients were examined on day 1, day 7,1 month, and 3 months after surgery. Best corrected visual acuity, Amsler grid, fundus biomicroscopy, Spectral Domain Optical Coherence Tomography (SD-OCT) and fundus auto-fluorescence (FAF) were performed in all patients after surgery. Structural abnormalities such as macular folds, macular epiretinal membrane, cystoid macular edema, and foveal disruption of the ellipsoid layer were observed on SD-OCT. Macular displacement was identified on FAF.

We identified metamorphopsia as post-operative visual impairment in 27 patients among 50 (54%). Clinical assessment found that a delay > 7 days between symptoms and surgery (p < 0.001), more than 2 detached quadrants (p=0.012), and stage C of proliferative vitreoretinopathy (p=0.035) were associated to metamorphopsia. Regarding multimodal imaging findings, only macular folds and macular displacement were significantly correlated with the occurrence of postoperative metamorphopsia (p <0.001).

Metamorphopsia is a common complaint after vitrectomy for RRD. Macular rotation and folds would be the main causes after complete and durable reapplication of the retina.