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Invited Commentary
April 22, 2021

Understanding Visual Acuity Outcomes After Retinal Detachment Repair by Assessing Photoreceptor Integrity on Spectral-Domain Optical Coherence Tomography

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
JAMA Ophthalmol. Published online April 22, 2021. doi:10.1001/jamaophthalmol.2021.0818

The annual incidence of rhegmatogenous retinal detachment is approximately 18 to 22 per 100 000 population1,2 and reported techniques for reattaching the retina include pneumatic retinopexy (PnR), scleral buckle, and pars plana vitrectomy (PPV). Recently, it has become increasingly common to repair a retinal detachment using vitrectomy and gas, given the higher anatomical success rate of this procedure. However, the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) showed that even though the anatomical success of PnR is lower than that of PPV, visual acuity outcomes were better and rates of postoperative metamorphopsia were lower in patients treated with PnR.3 It is important to note that long-acting gas tamponade (perfluoropropane) was used in 33 of 88 individuals (38%) in the PPV arm only. This difference could have influenced the anatomic success rates in favor of the PPV group with enhanced cataract formation in the PPV arm, which in turn could have influenced the visual acuity outcomes in favor of the PnR group. To understand further factors in the PnR arm that may have been associated with better functional outcomes, the study by Muni et al4 investigated the microstructural integrity of the outer retina on optical coherence tomography (OCT) between PnR and PPV groups.The results show a better preservation of the ellipsoid zone and external limiting membrane in the PnR group vs the PPV group, which, although not proving a causal relationship, has some biologic rationale to account for better functional outcomes when performing a PnR. Of note, it would be interesting to have further explorations by Muni et al4 to see if there were any confounding associations between use of perfluoropropane in the PPV group and worse microstructural integrity of the outer retina on OCT.

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