Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery

Purpose: To investigate the time course of foveal reattachment after successful surgery for macula-off retinal detachments. Design: Prospective comparative nonrandomized interventional trial. Participants: Thirty-three patients (16 female and 17 male, 65 3 years old) with a spontaneous rhegmatogenous retinal detachment with peripheral breaks and a shallow elevation of the fovea. Intervention: Nine patients were treated with episcleral buckle, cryotherapy, and, in selected cases, external drainage of subretinal fluid. Twenty-four patients were treated with vitrectomy, cryotherapy, and either complete (n = 8), or partial (n = 16) fluid-gas exchange. Patients with complete fluid-gas exchange were kept first in a prone position for 6 hours to help evacuation of subretinal fluid and, afterwards, on their side. Patients with partial fluid-gas exchange were kept in a supine position with the head elevated for 12 hours, allowing spontaneous absorption of submacular fluid. Patients were examined at 1, 6, and 10 to 12 months after surgery with a complete ophthalmic examination as well as optical coherence tomography (OCT). Mean follow-up was 10.0+/-0.5 months. Main Outcome Measure: Foveal attachment was determined clinically and by OCT. Results: Postoperative OCT examination 1 month after buckle surgery (n = 9) showed a small subclinical area of subfoveal fluid in 67% of patients (n = 6). Fluid was still present in 45% of cases (n = 4) at 6 months and in 11% of cases (n = 1) even at 12 months. Optical coherence tomography examination 1 month after vitrectomy showed a completely attached fovea with no subfoveal fluid in all cases (n = 24). Conclusions: Complete foveal reattachment after macula-off retinal detachment occurs without delay after vitrectomy, whereas subfoveal fluid may persist subclinically for several months in patients operated with a buckle. (C) 2004 by the American Academy of Ophthalmology.