BEYOND THE SURFACE: Investigating Silicone Oil's Impact on Macular Perfusion in Macula-Off Rhegmatogenous Retinal Detachment by Optical Coherence Tomography Angiography.

Abstract

The aim of this study was to compare macular vessel density (VD) in eyes with macula-off rhegmatogenous retinal detachment after vitrectomy with gas or silicone oil (SO) tamponade. Patients with macula-off rhegmatogenous retinal detachment who underwent vitrectomy with either gas or SO tamponade were included. Best-corrected visual acuity (BCVA) and VD in superficial and deep retinal capillary plexuses (superficial capillary plexus and deep capillary plexus), choriocapillaris (choriocapillaris plexus), and foveal avascular zone were assessed using optical coherence tomography angiography. Comparisons were made with the unaffected fellow eye. Fifty patients (average age: 57.9 ± 9.1 years) participated, with 26 eyes undergoing SO tamponade and 24 gas tamponade. No significant differences were found in baseline characteristics. Postoperative BCVA significantly improved in both groups. In the SO group, BCVA improved from 2.00 ± 0.77 logarithm of the minimum angle of resolution (20/2000 Snellen) to 0.95 ± 0.52 logarithm of the minimum angle of resolution (20/178 Snellen). In the gas tamponade group, BCVA improved from 2.12 ± 0.70 logarithm of the minimum angle of resolution (20/2636 Snellen) to 0.70 ± 0.55 logarithm of the minimum angle of resolution (20/100 Snellen) ( P < 0.001 for both groups). Moreover, the gas tamponade group achieved significantly better postoperative BCVA compared with the SO group ( P < 0.05). The silicone oil tamponade group exhibited significantly lower VD in superficial capillary plexus, deep capillary plexus, and choriocapillaris plexus quadrants ( P < 0.05), while gas tamponade showed no significant differences. This study reveals a decrease in VD in superficial capillary plexus, deep capillary plexus, and choriocapillaris plexus induced by SO tamponade, suggesting potential toxic effects on macular perfusion. Gas tamponade resulted in superior BCVA outcomes and preserved VD. Further investigation into SO's underlying mechanisms and careful patient selection is warranted. Gas tamponade may offer better outcomes for macula-off rhegmatogenous retinal detachment.