Analysis Of Related Factors Of Submacular Fluid After Retinal Detachment Surgery And The Effect Of Intraoperative Subretinal Lavage

Research BasicsRhegmatogenous retinal detachment(RRD)is a serious threat to vision.In the process of disease development,retinal breaks are formed,and the liquefied vitreous body enters into the subretinal space,which leads to the separation of retinal neuroepithelial layer and pigment epithelial layer.If RRD cannot be treated in time,the vision of patients will be seriously affected.Vitrectomy combined with silicone oil tamponade is a common method for the treatment of RRD.The rate of retinal anatomical reattachment is high after surgery.However,some patients may have the accumulation of submacular fluid(SMF)in the macular area after the examination by optical coherence tomography(OCT).The persistence of SMF may affect the recovery of vision.This study analyzed the related factors of SMF and the effect of SMF on the visual function of patients,and explored the preventive and therapeutic effect of subretinal fluid lavage during vitrectomy on the occurrence of SMF,and evaluated its safety.ObjectiveTo explore the related factors of SMF after vitrectomy for RRD and its influence on postoperative visual function of patients,as well as the preventive effect of subretinal lavage in vitrectomy on SMF and its safety evaluation.MethodsIn the first part,249 patients(249 eyes)with RRD who underwent vitrectomy in the First Affiliated Hospital of Zhengzhou University from September 2017 to March 2020 were enrolled.OCT was used to observe the macular morphology preoperative,1 month and 3 months after surgery.We divided patients into SMF group and non SMF group according to the results of OCT one month after surgery.We collected clinical data of different groups such as age,onset time,gender,axial length,lens status,the number of retinal-off quadrant,the number of retinal breaks,whether RRD affects the macular area preoperatively,whether it is caused by the inferior break,intraoperative drainage method,and best corrected visual acuity(BCVA)at each time point before and after operation.Logistic regression analysis was used to analyze the related factors of SMF after vitrectomy in RRD patients,and repeated measures analysis of variance was used to compare the differences of BCVA at each time point.In the second part,a total of 59 patients(59 eyes)with RRD admitted to the First Affiliated Hospital of Zhengzhou University from April to October 2020 were enrolled.Preoperative OCT examination showed that retinal detachment affected the macular area,with an average age of(49.20± 12.29)years.According to whether subretinal fluid was lavaged with balanced salt solution during operation,the patients were divided into lavage group(27 eyes)and non lavage group(32 eyes).The preoperative and postoperative clinical data,such as age,onset time,axial length,lens status,the number of retinal-off quadrant,the number of retinal breaks,fundus photography,OCT,BCVA and incidence of SMF were collected.Combined with the patient’s eye condition and examination results,we analyzed the preventive effect of subretinal lavage on postoperative SMF and the changes of visual function,and evaluated the safety of subretinal lavage with balanced salt solution in vitrectomy.ResultsPart one:1.One month after operation,OCT examination showed 32 cases(32 eyes)with SMF,accounting for 12.9%.Univariate analysis of preoperative and intraoperative clinical data:the age of patients in SMF group was younger than that in non SMF group(t=3.161,P=0.003);the average axial length of patients in SMF group was longer than that in non SMF group(Z=-2.143,P=0.032);there were no significant differences in sex composition,onset time,preoperative lens status,the number of retinal-off quadrant,the average number of retinal breaks between the two groups(all P>0.05);The proportion of macular-off RRD in SMF group was higher than that in non SMF group(x2=27.407,P<0.05);the proportion of retinal detachment caused by inferior retinal break in SMF group was higher than that in non SMF group(x2=7.081,P=0.008);the proportion of intraoperative drainage retinotomy in SMF group was lower than that in non SMF group,the difference was statistically significant(x2=6.215,P=0.013).2.By Logistic regression analysis,the results showed that age was the protective factor for the occurrence of postoperative submacular fluid(OR=0.970,P=0.023),and macular-off RRD and retinal detachment caused by the inferior retinal break were the risk factors for the occurrence of submacular fluid after the treatment of RRD(OR=8.844,2.443,both P<0.05).3.Three months after operation,OCT showed that all patients in SMF group still had SMF.In SMF group,6 eyes(18.8%)had more SMF absorption at 3 months than 1 month after operation.4.Repeated measurement ANOVA and LSD-t test showed that 1 month and 3 months after operation,BCVA of SMF group and non SMF group was significantly higher than that before(F=30.089,278.231,both P<0.05).And BCVA of SMF group and non SMF group was significantly different at different time points(FGroup=13.693,Ftime=120.906,both P<0.05).Part two;1.There were no significant differences in ages composition,onset time,axial length,the average number of retinal breaks between the lavage group and non lavage group(all P>0.05).And there were no significant differences in sex composition,preoperative lens status,the number of retinal-off quadrant,the proportion of drainage retinotomy and the proportion of RRD caused by inferior hole either(all P>0.05).2.SMF occurred in 2 eyes(7.4%)in the lavage group and 9 eyes(28.1%)in the non lavage group 1 month after operation.The difference in the incidence of SMF between the two groups was statistically significant(x2=4.144,P=0.042).OCT examination showed that SMF was absorbed in 2 eyes of the lavage group(100.0%)at 3 months after operation,and in the non lavage group,SMF was absorbed in 3 eyes(33.3%),but SMF existed in all eyes.3.Repeated measurement AN OVA analysis of variance and LSD-t test showed that 1 month and 3 months after operation,BCVA of lavage group and non lavage group was significantly higher than that before(F=42.930,39.374,both P<0.05).And BCVA of lavage group and non lavage group was significantly different at different time points(FGrroup=4.448,Ftime=80.303,both P<0.05).4.All operations were successfully completed,and no serious complications such as endophthalmitis,vitreous hemorrhage,choroidal detachment occurred in any eyes.Two eyes in the lavage group had high intraocular pressure after operation,and three eyes in the non lavage group had high intraocular pressure after operation.Four eyes returned to normal within 3 days after topical application of eye drops for lowering intraocular pressure,and silicone oil entered the anterior chamber in one eye,but the patient gradually returned to normal after symptomatic treatment such as anterior chamber puncture.Conclusions1.Young patients are more likely to have SMF after vitrectomy for RRD.Retinal detachment involving macular area and retinal detachment caused by inferior retinal break will increase the probability of SMF after surgery.2.The existence of SMF after vitrectomy for RRD may affect the recovery of visual function.3.Subretinal fluid lavage with balanced salt solution in vitrectomy for RRD patients can reduce the incidence of postoperative SMF and promote the recovery of postoperative vision.It is also safe and effective.