Evaluation of Macular Perfusion in Successfully Reattached Macula-off Diabetic Tractional Retinal Detachment

Current imaging techniques based on optical coherence tomography (OCT) angiography are useful for observing different retinal microcirculation patterns. The primary purpose of this chapter was to describe the functional, structural, and serial perfusion postoperative outcomes of successfully reattached macula-off tractional retinal detachment (TRD). Patients who underwent a successful diabetic vitrectomy were analyzed. The mean differences between the preoperative best-corrected visual acuity (BCVA), 3-month BCVA, and final postoperative BCVA were statistically significant (p < 0.05). The duration of vision loss before surgery was 11.6 ± 2.3 weeks (mean ± standard deviation (SD)).

The mean duration (± SD) of the resolution of macular detachment was 3.6 ± 1.7 weeks in the pure macular TRD group and 1.8 ± 0.8 weeks in the combined tractional and rhegmatogenous macular detachment (p < 0.05) group. The mean follow-up duration of all patients was 11.4 ± 5.7 months (mean ± SD). Longitudinal multimodal imaging tests revealed abnormal superficial and deep microcirculation patterns with multiple microabnormalities in the foveal avascular zone and different but distinct areas of the non-perfused macula in different OCT angiography slabs. Additionally, disorganization of the retinal inner layers and chronic ischemic macular edema were observed in 82% of eyes examined using the spectral domain (SD) OCT. Therefore, these data suggest that despite the successful anatomical reattachment of the macula, long-term postoperative microcirculatory abnormalities were detected in both groups; however, these abnormalities were predominantly accompanied by severe persistent ischemia in the recurrent TRD group due to the presence of multiple microcirculatory defects.

Keywords: Choriocapillaris subfoveal plexus, Deep vascular plexus, Disorganization of the retinal inner layers, Long-term proliferative diabetic retinopathy complications, Macula-off tractional retinal detachment, Optical coherence tomography angiography, Macular perfusion indices, Perfusion microcirculatory abnormalities, Ischemic macula, Chromatic visual field testing, Microperimetry, Multifocal electroretinography, Secondary complicated retinal detachment, Superficial vascular plexus, Vessel density.