Delayed rhegmatogenous retinal detachment post macular surgery – a multicentric study

Purpose: To report the anatomic and visual outcomes of eyes developing delayed rhegmatogenous retinal detachment (RRD) after macular surgery. Methods: This was a retrospective, multicentric study including eyes undergoing RRD repair at least 3 months after macular surgery for either full-thickness macular hole (FTMH) or epiretinal membrane (ERM). Anatomic and functional assessment, i.e., pre- and postoperative best-corrected visual acuity (BCVA), indications and details of macular and RRD surgery, time interval from macular surgery to RRD, intraocular tamponade, location, extent of RRD, and nature of retinal break, was performed. Results: Sixteen out of 2,906 eyes (0.55%) undergoing macular surgery developed RRD after 8.4 ± 5.8 months (mean ± SD). Intraoperative peripheral retina evaluation showed missed/de novo break (11 eyes; 68.75%), no identifiable break i.e., probable microbreak (two eyes; 12.5%), giant retinal tear (two eyes; 12.5%), and retinoschisis related break (one eye; 6.25%). Anatomical success, i.e., attached retina after one surgery, was seen in 14 eyes (87.5%). BCVA worsened from 0.6 ± 0.3 logMAR (Snellen equivalent 20/80) at baseline to 0.9 ± 0.8 logMAR (20/160) through the last visit ( P < 0.001). Conclusion: RRD after macular surgery occurs predominantly via missed/de novo retinal breaks. A significant percentage (50%) of eyes showed worse visual acuity compared with baseline despite successful retinal reattachment.