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Bulgarian Review of Ophthalmology

Analysis of microstructural changes in the macular area in patients with macula-off and macula-on rhegmatogenous retinal detachment by optical coherence tomography angiography

Ralitsa Angelova


Aim: The aim of this article is to evaluate the pathological vascular changes in the macular area in patients with rhegmatogenous retinal detachment using optical coherence tomography angiography (OCTA); to apply statistical analysis of angiographic OCT indices (Vessel Density and Flow) before and after surgery; and to establish a relationship between the achieved visual acuity after surgery and the microstructural changes in patients with macula-off and macula-on retinal detachment.

Materials and Methods: A prospective 12-month study of 24 patients (total 48 eyes) with monocular rhegmatogenous retinal detachment who were subjected to primary vitrectomy with silicone oil tamponade was conducted. The patients were divided into two groups: patients with macula-off and such with macula-on. All patients were followed up after implantation and after evacuation of the silicone oil. OCT on the macula and optic nerve, including OCTA - OptoVue AngioVue - AngioAnalytics, with density in the superficial and deep vascular plexuses and flow, were performed.

Results: After the evacuation of silicone oil in the macula-off group, it was observed that there were signs of thinning in the macular area and loss of ganglion cell complex (GCC) density. No such finding was observed in the macula-on group. In the group with macula-off, the following statistically significant results were found: reduction of density from the whole ETDRS area (whole en-face) measured after the surgery, compared with measurements on the 2nd month after the evacuation of the silicone oil in the superficial vascular plexus; reduction of density measured in the affected eye on the 2nd month after evacuation of silicone oil compared to those measured in the healthy eye in the deep vascular plexus. No statistically significant relationship between the measured indices was found in the macula-on group. No statistically significant relationship between the flow indices was observed in both groups, both in the affected eye, before and after surgery, but also when comparing the affected and the healthy eye.

Conclusion: The present study offers an attempt to quantify the changes in the macular area after a successful surgery of rhegmatogenous retinal detachment. Although the macular structure is anatomically restored, microvascular changes are demonstrated in macula-off cases. OCTA is an additional diagnostic method for correct prognosis of visual acuity after retinal detachment surgery.


retina, rhegmatogenous retinal detachment, silicone oil tamponade, macula, vessel density, OCT angiography

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About The Author

Ralitsa Angelova
Vision Eye Hospital , Sofia, Bulgaria