Persistent subretinal fluid following diabetic tractional retinal detachment repair: risk factors, natural history, and management outcomes

• Published in: International ophthalmology Vol. 41; no. 2; pp. 453 - 464
• Main Authors: Algethami, Ahmed, Talea, Mohammed, Alsakran, Wael A., Mura, Marco, Alsulaiman, Sulaiman M.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.02.2021; Springer Nature B.V
• Subjects: Acuity; Diabetes; Diabetes mellitus; Eye; Eye (anatomy); Fovea; Medicine; Medicine & Public Health; Ophthalmology; Original Paper; Retina; Retinal detachment; Risk analysis; Risk factors; Risk management; Statistical analysis; Surgery; Visual acuity; Subretinal fluid; Diabetic tractional detachment; Combined tractional-rhegmatogenous detachment; Submacular fluid; Diabetic pars plana vitrectomy
• ISSN: 0165-5701; 1573-2630
• DOI: 10.1007/s10792-020-01595-y

Purpose To study the natural history, anatomical and functional outcomes of persistent subretinal fluid (SRF) after pars plana vitrectomy (PPV) for diabetic tractional retinal detachment (TRD) and combined traction-rhegmatogenous retinal detachment (TRRD). Methods Retrospective interventional case series of 43 patients (46 eyes) with persistent SRF following PPV for diabetic TRD or combined TRRD from January 2010 to December 2017 at single tertiary institution. Primary outcomes included best corrected visual acuity (BCVA) and central foveal thickness (CFT). Results Thirty-one eyes (67.4%) had macula-off TRD, 5 (10.9%) had fovea-threatening TRD and 10 (21.7%) had combined TRRD. The mean (± SD) duration of decreased vision was 48.0 ± 58.2 weeks. The mean follow-up duration was 21 ± 13.2 months. Residual macular SRF was detected by optical coherence tomography in all eyes at 3 months and in 10 eyes (23.8%) at 12 months after surgery. Only 3 eyes (6.5%) had persistent SRF at final follow up. The mean time to resolution was 10.6 ± 4.1 months [range 6.0–23.0]. Thirteen eyes received additional intervention to address SRF. The mean CFT gradually improved until final follow-up ( P -value < 0.001). The mean BCVA improved from 1.62 ± 0.88 LogMAR at presentation to 1.05 ± 0.76 LogMAR at final follow up. No statistically significant difference in final BCVA was found between eyes that had intervention and eyes that were observed ( P value = 0.762). Conclusion Persistent SRF after diabetic vitrectomy resolves slowly over time with gradual improvement in visual acuity. Additional drainage of persistent SRF may not be necessary.