Macular Microvascular Alterations and Visual Outcomes Following Successful Retinal Detachment Surgery in a Sub-Saharan African Context.

Background: Retinal detachment disrupts blood flow and oxygenation, potentially causing persistent microvascular damage even after successful reattachment surgery. This study retrospectively evaluates macular microvascular changes using Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) and explores their relationship with visual function in patients following successful retinal detachment surgery (RDS).

Aim: To report macular microvascular changes using optical coherence tomography and optical coherence tomography angiography (OCTA) and their relationship with visual function in patients following successful retinal detachment surgery (RDS).

Methods: A retrospective review of medical records was conducted for patients who underwent rhegmatogenous retinal detachment (RRD) surgery at the Eye Foundation Hospital, Lagos, Nigeria, between January 2022 and December 2022. Patients meeting predefined inclusion criteria were included in the analysis.

Results: Data from 64 eyes of 38 patients were analyzed, while 12 contralateral eyes were excluded. Postoperative visual acuity improved significantly compared to preoperative levels (P = 0.018). The mean central retinal thickness (CRT) in operated eyes was 292.7 ± 161.0 µm, significantly greater than the control group (235.6 ± 14.0 µm, P = 0.036). Macula-on RRD cases achieved better visual outcomes (63.6%) compared to macula-off cases (36.4%, P = 0.024). The foveal avascular zone (FAZ) area in both the superficial capillary plexus and deep capillary plexus was significantly larger in control eyes (0.31 ± 0.11 mm²) compared to eyes with acceptable visual outcomes (0.26 ± 0.11 mm²) and those without (0.22 ± 0.11 mm², P = 0.017). Eyes with acceptable visual outcomes had a higher proportion of continuous external limiting membrane (ELM) (90.9%) and ellipsoid zone (EZ) (90.9%) compared to eyes without acceptable outcomes (ELM: 55.6%, EZ: 77.8%), though these differences were not statistically significant (P = 0.075 and P = 0.556, respectively). Mean superficial and deep foveal vessel density showed no significant difference between groups.

Conclusion: Macula microvascular changes significantly influence visual recovery after RDS. Parameters such as subfoveal CRT and FAZ area are key predictors of visual outcomes, while outer subfoveal retinal features like ELM and EZ integrity improve over time. Early intervention, coupled with OCTA monitoring, can optimize postoperative care and predict visual outcomes. This study underscores the importance of macular integrity and preoperative visual acuity in achieving favorable long-term visual function.