Analysis Of The Causes Of Postoperative Metamorphopsia After Successful Surgery For Rhegmatogenous Retinal Detachment

Purpose:To investigate the reasons for the metamorphopsia after successful surgery in patients with rhegmatogenous retinal detachment,we analyze the microstructure changes of the macular retina,summarize the reasons for the metamorphopsia after surgery and compare the causes of metamorphopsia after undergoing pars plana vitrectomy(PPV)with scleral buckle surgery(SB).Methods:To analysis the medical records of 56 patients(56 eyes)who complained of metamorphopsia among the 298 patients after successful surgery for rhegmatogenous retinal detachment in our hospital(the Department of Ophthalmology of the Second Hospital of Jilin University).All of them underwent pars plana vitrectomy(PPV)or scleral buckle surgery(SB)and the retinal has been reattached examed by front mirror.The eyes were divided into 2 groups based on the surgical procedure.The visual acuity,intraocular pressure,axial length examination fundus and OCT were measured before operation and the visual acuity,OCT were measured after operation.All patients were examined by spectral-domain optical coherence tomography(SD-OCT)to observe the microstructure changes of the macular retina and the integrity of the ellipsoid zone(EZ)and external limiting membrane(ELM)at 1 month,3 months,6 months and 12 months after surgery.The differences in the microstructure of the retina were compared between the two groups and provide some perspective on it.Results:1.There were no significant differences between the 2 groups in the baseline characteristics,including the duration from onset,intraocular pressure,axial length,the integrity of the ELM and the EZ line,retinal hole,and Preoperative macular situation(P>0.05).2.There were differences between the 2 groups in preoperative best corrected visual acuity,The average BCVA was significantly better in the SB group than in the PPV group(P<0.05).But both groups have the significant improvement in the BCVA from baseline at 1 month,3 months,6 months and 12 months after surgery(P<0.05).3.There were no significant differences in the postoperative metamorphopsia rates between the 2 groups at 1,3,6 or 12 months after surgery.4.(1)There were significant differences in the causes of the postoperative metamorphopsia measured with OCT between the 2 groups at 1 month,3 months,6 months and 12 months after surgery(P<0.05).(2)The difference of metamorphopsia caused by subretinal fluid at 1 month,3 months,6 months was significant in the two groups(P<0.05)but there was no significant differences at 12 month.(3)There was no significant difference between the two groups in retinal edema,EZ rupture,ELM rupture,EZ combined with ELM rupture,macular epiretinal membrane,macular hole,retinal thinning,no abnormal OCT in the postoperative 1,3,6 and 12 months.(4)The prevalence of postoperative metamorphopsia had significant increase in macula-off rhegmatogenous RD compared with macula-on rhegmatogenous RD(P<0.05).(5)There were no statistically significant differences in vitrectomy retinal detachment repair with silicone oil or gas tamponade(P>0.05).5.In the PPV group,elevated intraocular pressure was observed in 2 eyes.No elevated intraocular pressure was observed in SB group.In addition to elevated intraocular pressure no intraoperative postoperative complications were observed.Conclusion:1.The causes of postoperative metamorphopsia were: subretinal fluid,retinal edema,macular epiretinal membrane,macular hole,retinal thinning,EZ rupture,ELM rupture,EZ combined with ELM rupture,normal OCT.2.Compared with macula-on rhegmatogenous RD,the rate of postoperative metamorphopsia was high in macula-off rhegmatogenous RD.3.There were significant differences in the causes of the postoperative metamorphopsia between the two groups,the SB group was more likely to develop subretinal fluid.4.This study showed no significant differences in the postoperative metamorphopsia rates in the treatment of RRD between pars plana vitrectomy,scleral buckle.