Swept-Source Optical Coherence Tomography Angiography After Rhegmatogenous Retinal Detachment Treated With Different Approaches

<b>Purpose:</b> To present long-term changes in swept-source optical coherence tomography angiography (SS-OCTA) after different approaches in rhegmatogenous retinal detachment. <b>Methods:</b> This was a retrospective study of patients after segmental buckling, circumferential buckling, primary vitrectomy, or combined surgery (vitrectomy and scleral buckling) in whom SS-OCTA was performed at 1 month and 24 months after surgery. Central retinal thickness, central choroidal thickness visual acuity, macula-on vs macula-off status, vascular density, and fovea avascular zones (FAZs) in superficial and deep vascular retinal layers were analyzed. <b>Results:</b> We included 150 eyes of 150 patients. Final visual acuity was better in macula-on vs macula-off cases (<i>P</i> < .05). In comparison with the fellow eyes, final central choroidal thickness was lower in macula-off retinal detachments (<i>P</i> = .042). Deep vessel density was also lower in macula-off eyes when compared with their fellow eyes, which was of high significance in lower quadrants (<i>P</i> = .008). Patients after primary vitrectomy had lower deep FAZ, superficial vessel density, and deep vessel density when compared with eyes after circumferential and segmental buckling (<i>P</i> = .005, <i>P</i> = .037, and <i>P</i> < .001, respectively). After segmental and circumferential buckling, deep vessel density increased between the first and last follow-up visits (<i>P</i> = .018). After primary vitrectomy, no improvements in deep vessel densities after surgery were observed. Macular edema was observed in 13 eyes during the observation period. Multiple variate analysis revealed that the only factor responsible for later occurrence of macular edema was low deep vessel density 1 month after surgery. <b>Conclusion:</b> Segmental buckling does not affect vasculature when visualized with SS-OCTA. Long-term changes observed after circumferential buckling were less pronounced than after primary vitrectomy or combined procedures using perfluorocarbon liquid, silicone oil, and internal limiting membrane peeling. Macula-off patients had a lower postoperative vessel density, correlating with the development of macular edema and decreased final vision.