Impact of Rhegmatogenous Retinal Detachment Repair on Macular Microvascular Changes Detected by Optical Coherence Tomography Angiography (OCTA)

Purpose Rhegmatogenous retinal detachment (RRD) occurs when the sensory retina separates from the retinal pigment epithelium (RPE) due to a retinal break. Pars plana vitrectomy (PPV) with gas or silicone oil tamponade is the primary surgical approach for RRD repair. This study evaluates microvascular changes in eyes undergoing PPV for RRD using optical coherence tomography angiography (OCTA) and compares outcomes between macula-on and macula-off cases. Methods This retrospective study included 45 patients (21 macula-on, 24 macula-off) who underwent RRD repair. OCTA was used to assess central retinal thickness (CRT), vessel density in the superficial (sVD) and deep capillary plexus (dVD), and the foveal avascular zone (FAZ). Comparisons were made between affected and fellow eyes, as well as between macula-on and macula-off cases. Results CRT was significantly different between macula-on and macula-off groups (p < 0.01). A weak but significant correlation was found between best-corrected visual acuity (BCVA) and FAZ area (r = 0.21, p = 0.018). Inferior detachments had lower dVD (32.16 ± 5.22%) than other quadrants (p < 0.05). dVD was reduced in affected eyes compared to fellow eyes in both macula-on (p = 0.01) and macula-off groups (p < 0.01), while sVD decreased significantly only in macula-off cases (p = 0.03). Conclusion RRD repair significantly impacts retinal microvasculature, particularly dVD reduction in macula-off cases and inferior RRDs. The correlation between FAZ enlargement and BCVA suggests microvascular alterations influence visual recovery. These findings highlight the need for further investigation into vascular recovery strategies after RRD repair.