The long-term outcome of eyes with unexplained visual loss after gas tamponade for macula-on retinal detachment

Purpose: To analyze the long-term outcome of eyes suffering from unexplained visual loss after gas tamponade for primary macula-sparing rhegmatogenous retinal detachment (RRD). Methods: Cross-sectional analysis of all eyes with macula-on RRD experiencing an unexplained loss of vision after gas reabsorption that were treated and followed from 2010 to 2019. The investigational work-up included: best-corrected visual acuity (BCVA), clinical examination, spectral-domain optical coherence tomography (SD-OCT) and automated computerized perimetry. Results: The 9 eyes of the 9 patients were analyzed after 5.9±2.4 years. BCVA improved by 0.54±0.50 logMAR from baseline, achieving a final value of 1.17±0.52 logMAR (∼20/320; p=0.0115). The thicknesses of the macula, of the macular ganglion cells and of the retinal nerve fiber layers were unchanged compared to the baseline, as well as the rate of ellipsoid zone defects (22.2%). The proportion of eyes with microcystoid macular edema (MME) significantly decreased to 44.4% (p=0.0294). Perimetry mean deviation increased from a baseline value of -18.06±2.72 to -17.23±2.29 dB (p=0.0390), with an unchanged pattern standard deviation (p=0.1289). In general, a reduction of the scotomata relative depth from baseline was evident in all eyes. Conclusions: Eyes with macula-on RRD suffering from unexplained visual loss after gas reabsorption, despite disclosing an overall unchanged structural macular morphology, showed a moderate, but significant, visual and perimetric improvement in the long-term.