Macular edema after rhegmatogenous retinal detachment repair: risk factors, OCT analysis, and treatment responses

Purpose To investigate risk factors, imaging characteristics, and treatment responses of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair. Methods Consecutive, retrospective case–control series of patients who underwent pars plana vitrectomy (PPV) and/or scleral buckling (SB) for RRD, with at least six months of follow-up. Clinical and surgical parameters of patients with and without CME (nCME), based on spectral-domain optical coherence tomography (OCT), were compared. Results Of 99 eyes enrolled, 25 had CME while 74 had nCME. Patients with CME underwent greater numbers of surgeries ( P < 0.0001). After adjusting for number of surgeries, macula-off RRD ( P = 0.06), proliferative vitreoretinopathy (PVR) ( P = 0.09), surgical approach (PPV and/or SB, P = 0.21), and tamponade type ( P = 0.10) were not statistically significant, although they all achieved significance on univariate analysis ( P = 0.001 or less). Intraoperative retinectomy ( P = 0.009) and postoperative pseudophakia or aphakia ( P = 0.008) were more frequent in the CME group, even after adjustment. Characteristics of cCME on OCT included diffuse distribution, confluent cysts, and absence of subretinal fluid or intraretinal hyperreflective foci. Macular thickness improved significantly with intravitreal triamcinolone ( P = 0.016), but not with anti-vascular endothelial growth factor agents ( P = 0.828) or dexamethasone implant ( P = 0.125). After adjusting for number of surgeries and macular detachment, final visual acuities remained significantly lower in the CME vs nCME group ( P = 0.012). Conclusion Risk factors of CME include complex retinal detachment repairs requiring multiple surgeries, and pseudophakic or aphakic lens status. Although this cCME was associated with poor therapeutic response, corticosteroids were the most effective studied treatments.