Recalcitrant Macular Edema after Pseudophakic Rhegmatogenous Retinal Detachment Repair: Risk Factors and Response to...

Area of Science:

• Ophthalmology
• Retinal Surgery
• Medical Retina

Background:

• Post-surgical macular edema (PSME) following rhegmatogenous retinal detachment (RRD) repair can impact visual outcomes.
• Identifying risk factors for recalcitrance to topical therapy is crucial for effective management.
• Intravitreal dexamethasone implant (DEX-I) is an option for refractory cases.

Purpose of the Study:

• To determine risk factors associated with PSME recalcitrance to topical therapy after RRD repair.
• To evaluate the response of recalcitrant PSME to DEX-I treatment.

Main Methods:

• Retrospective analysis of pseudophakic patients undergoing vitrectomy for RRD with subsequent PSME.
• Regression modeling to identify clinical, surgical, and OCT parameters linked to topical therapy recalcitrance.
• Comparison of best-corrected visual acuity (BCVA) and central macular thickness (CMT) between responsive and recalcitrant PSME groups, including DEX-I treated eyes.

Main Results:

• PSME occurred in 11.7% of RRD repairs (42/361 eyes).
• Disrupted retinal outer layers and hyperreflective foci (HRF) were significantly associated with recalcitrant PSME (p=0.02 and p=0.01, respectively).
• HRF increased the risk of recalcitrance (OR: 7.69; p=0.02).
• Eyes treated with DEX-I for recalcitrant PSME showed poorer BCVA and greater CMT fluctuations (p<0.01).
• A 42.8% re-implantation rate was noted in DEX-I treated eyes, with no ocular hypertension complications.

Conclusions:

• Hyperreflective foci (HRF) are a significant risk factor for PSME recalcitrance to topical therapy.
• Intravitreal dexamethasone implant (DEX-I) demonstrated a limited treatment response in PSME cases with HRF.