911334

review-article2020
EJO0010.1177/1120672120911334European Journal of OphthalmologyCoppola et al.

EJO European
Journal of
Ophthalmology
Review (On Invitation Only)

European Journal of Ophthalmology

Macular optical coherence tomography

1­–12
© The Author(s) 2020
Article reuse guidelines:
findings after vitreoretinal surgery for sagepub.com/journals-permissions
https://doi.org/10.1177/1120672120911334
DOI: 10.1177/1120672120911334

rhegmatogenous retinal detachment journals.sagepub.com/home/ejo

Michele Coppola1, Alessandro Marchese1,2,

Maria Vittoria Cicinelli1,2 , Alessandro Rabiolo1,2,
Chiara Giuffrè1,2, Silvia Gomarasca1, Giuseppe Querques2
and Francesco Bandello2

Abstract
The primary aim of this study was to summarize and illustrate the main structural cross-sectional optical coherence
tomography findings encountered after vitreoretinal surgery for rhegmatogenous retinal detachment. This was a non-
systematic review of literature on structural cross-sectional optical coherence tomography findings after vitreoretinal
surgery for rhegmatogenous retinal detachment. Adequate illustrations of the main findings described were found after a
retrospective analysis of imaging and charts of patients operated at the department where this study was performed. The
main structural cross-sectional optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous
retinal detachment included persistent subretinal fluid, subretinal blebs, retinal folds, subretinal perfluorocarbon liquids,
macular alterations related to silicone oil, epiretinal membranes, proliferative vitreoretinopathy, cystoid macular edema,
macular holes, and recurrent retinal detachment. In conclusion, optical coherence tomography was a useful tool after
vitreoretinal surgery for rhegmatogenous retinal detachment. Some optical coherence tomography findings may not be
evident on fundus examination, and optical coherence tomography can reveal essential details for the clinical management
and the visual prognosis. Other findings, despite being visible on funduscopic examination, may be better assessed with
the aid of optical coherence tomography. All these elements contribute to support the importance of tomographic
assessment in the follow-up of eyes treated for vitreoretinal conditions.

Keywords
Retinal detachment, retina, pars plana vitrectomy, vitreous, optical coherence tomography, techniques of retinal
examination, retinal breaks

Date received: 5 November 2019; accepted: 14 February 2020

Introduction OCT can provide information before and after surgical

Optical coherence tomography (OCT) imaging has been an
object of great innovation and improvements in the recent
years, due to its ability to provide an in vivo assessment of
the anterior segment, as well as of the retina and the choroid
without the need of invasive procedures.1–3 Structural
cross-sectional OCT has been gaining a pivotal role in the
management of diverse retinal conditions, namely, diabetic
macular edema, age-related macular degeneration, epireti-
nal membrane (ERM), macular hole (MH), and central
serous retinopathy.4,5 Despite the diagnosis of rhegmatoge-
nous retinal detachment (RRD) being clinical or by ultra-
sonography (in opaque media), structural cross-sectional
repair with a relevant functional and prognostic value.6,7
Both qualitative and quantitative OCT analysis of dif-
ferent parameters, that is, central macular thickness
(CMT), outer retinal layer morphology, intraretinal fluid
1
Department of Ophthalmology, San Gerardo Hospital, Monza, Italy
2
Department of Ophthalmology, IRCCS San Raffaele Scientific Institute,
Vita-Salute San Raffaele University, Milan, Italy
Corresponding author:
Giuseppe Querques, Department of Ophthalmology, ISan Raffaele
Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60,
20132 Milan, Italy.
Email: giuseppe.querques@hotmail.it
2 European Journal of Ophthalmology 00(0)
Figure 1.  Persistent subretinal fluid. Persistent subretinal fluid appears on structural cross-sectional OCT as a hyporeflective clear
subretinal detachment (white arrows) above the retinal pigment epithelium.
or subretinal fluid (SRF), in the macular region can help to
predict visual outcome and may explain incomplete recov-
ery after retinal reattachment.8
Thanks to its velocity and repeatability, patients can be
regularly imaged with OCT during the follow-up, gather-
ing clues of the effective reattachment of the neuroretina,
the state of the photoreceptors, the eventual amount of
residual SRF, and the potential postoperative complica-
tions.9,10 In cases with unexpected visual loss after the sur-
gery or poor postoperative outcomes, OCT can drive the
differential diagnosis and suggest the most appropriate
management.11 Important indications for surgical reinter-
vention can be obtained combining the clinical data with
morphologic imaging. For these reasons, OCT can com-
plete clinical evaluation and may be associated with the
standard follow-up after surgery, particularly in case of
suboptimal visual outcome.
In this review, we summarize the main structural cross-
sectional OCT findings that can be encountered after mod-
ern vitreoretinal surgery for RRD, with a focus on macular
pathologies.12 Despite its comprehensive nature, this
review is not meant to be an exhaustive list of all the pos-
sible postsurgical scenarios but is aimed to provide a guide
for both novice and expert vitreoretinal surgeons.
Subretinal fluid (SRF)
Persistent SRF.  Persistent SRF is a common postoperative
finding encountered in diverse retinal repair techniques,
including scleral buckling,13 pneumatic retinopexy,14 and
vitrectomy (Figure 1).15,16 Its prevalence is high in the very
early postoperative period, up to 94% of cases irrespec-
tively to the success of the primary surgery. The SFR
progressively disappear within the first recovery weeks.17
On structural cross-sectional OCT, it appears as a clear
subretinal hyporeflective space above the retinal pigment
epithelium (RPE) and can present either as a single lesion
or multiple pockets of loculated fluid.18 Organized fluid
collections are reabsorbed more slowly than free fluid
without loculations.19
The pathogenesis of SRF is still under debate; a blood–
retinal barrier disruption has been hypothesized among the
causes of SRF leakage, even in the absence of dye leakage
on fluorescein angiography.15,20 An alternative explanation
might reside in the disturbance of the adherence between
the RPE and the Bruch’s membrane, which could, in turn,
impair the drainage of fluid from the subretinal space to
the choroid.21
Persistent SRF is found more frequently after scleral
buckling22 and in patients with no posterior vitreous
detachment (PVD);13,23 conversely, age, gender, refractive
error, nature and duration of retinal detachment, type and
persistence of tamponading agent, and positioning after
the surgery do not seem to influence the rate of SRF disap-
pearance. Furthermore, persistent SRF has been recently
associated with increased subfoveal choroidal thickness;
this finding relates SRF to the pachychoroid spectrum, and
this could open potential new therapeutic scenarios for the
management of this condition.24
The natural history of SRF is to be reabsorbed within
the first 12 months, with rapid visual recovery and no con-
sequences on the external retinal layers.25 Only a small
percentage (6%–9%) of eyes present persistent SRF
after12 months.16,26 Although long-lasting SRF has been
associated with worse functional outcome, metamorphop-
sia, and loss of depth perception in the early postoperative
Coppola et al. 3
Figure 2.  Subretinal blebs. Subretinal blebs are pockets of fluid found after successful retinal reattachment. On structural cross-
sectional OCT, they appear as hyporeflective multiple bleb-like serous detachments.
period, its influence on the long-term visual acuity is con-
troversial. Some pieces of evidence suggest that presence
and amount of fluid do not correlate either with the final
functional outcome or the time required for reabsorb-
tion.27,28 Kim et al. found that persistent SRF variously
affects the visual recovery and the retinal structure after
RRD surgery, according to preoperative visual acuity. In
detail, in patients with poor preoperative visual acuity and
those with more severe retinal involvement, the persis-
tence of fluid might negatively impact the recovery rate.
However, once SRF is completely absorbed, no significant
differences in long-term retinal structural and functional
outcome were noted.25
On the other hand, long-standing SRF might be associ-
ated with sight-threatening complications, including RPE
atrophy and macular thinning, up to the development of
MH. In our clinical experience, young patients with a
healthy RPE tolerate well a small amount of residual SRF
at the end of the surgery, with no effects on the final retinal
reattachment and visual acuity; residual SRF is quickly
reabsorbed during the first postoperative days.4
Despite surgical reintervention and drainage of the sub-
macular fluid is often considered an overly invasive
maneuver for such a relatively benign condition, a guarded
surgical technique has been proposed in eyes with persis-
tent SRF and non-recovering visual acuity; the procedure
is based on an OCT-guided retinotomy, internal drainage
of SRF through active aspiration by a 23-gauge needle,
30% sulfur-hexafluoride gas tamponade, and peri-retinot-
omy laser. The drainage is able to remove all the persistent
fluid, with no significant changes in the final visual
acuity.29
Subretinal blebs.  Subretinal blebs are multiple (>3), SRF
pockets after successful surgery for RRD, achieved either
by pars plana vitrectomy, cryotherapy, or scleral buckling
(Figure 2).30–32 Subretinal blebs are closely related with
persistent SRF and might represent an intermediate step
immediately before the complete reabsorption of SRF. The
incidence of subretinal blebs can be as high as 20% of
treated RRDs, being more common in young patients.30
Subretinal blebs can develop anywhere in the areas of the
reattached retina, but they are rare under large retinal ves-
sels, which are often the first areas of reattachment.30 Vis-
ual acuity may be affected if the macula is involved, and
some degree of metamorphopsia can develop if subretinal
blebs transitory distort the normal retinal anatomy.
Subretinal blebs are most commonly observed in the
first months after the surgical procedure, and their pres-
ence does not indicate surgical failure; indeed, they are
associated with slow, spontaneous reabsorption of SRF
over months before complete retinal reattachment.30
Different pathogenetic pathways have been hypothesized,
including surgical damage of the retina, RPE and choroi-
dal vasculature, breakdown of blood–retinal barrier with
prominent exudation of proteins, undulations of the
detached retina (similar to those observed on OCT in mac-
ula-off detachments), and active interaction between RPE
and photoreceptors during the reattachment phase.30,31,33
Advances in ophthalmic imaging such as the OCT devices
associated with scanning laser ophthalmoscopy (SLO)
facilitate the detection of subretinal blebs and their follow-
up over time. After detection, subretinal blebs may become
transiently more prominent, narrower or higher, and then
slowly regress over months.30 Once reabsorbed, subretinal
blebs do not tend to recur.31
Recurrent retinal detachment.  Recurrent retinal detachment
is a complication of primary detachment repair, occurring
in approximately 5%–10% of treated cases; the prevalence
varies according to several factors, including the features of
the primary detachment, the surgical timing, the surgeon
experience, the occurrence of intraoperative complications,
the operative technique, and the concomitant eye disorders.
Despite the recurrence of retinal detachment is usually
clear on funduscopic examination, OCT can confirm the
diagnosis and, more importantly, can assess the macular
involvement, a pivotal modifier of surgical timing. The
presence of a detached retina on structural cross-sectional
OCT is usually associated with a mirror artifact because the
4 European Journal of Ophthalmology 00(0)

Figure 3.  Recurrent retinal detachment. Structural cross-sectional OCT shows recurrent retinal detachment involving the macula.
The presence of a detached retina on structural cross-sectional OCT scans is usually associated with a mirror artifact (arrow)
because the focus of the retina lies on different planes.

Figure 4.  Chorioretinal folds. On structural cross-sectional OCT, chorioretinal folds appear as undulating folds in the choroid,
RPE, and neurosensory retina.

focus of the retina lies on different planes (Figure 3).34
Structural cross-sectional OCT of the detached retina can
also provide details of the anatomical integrity of the differ-
ent retinal layers, which can be a determinant factor for
clinical prognosis.35
Retinal folds
Different types of folds can occur after RRD repair sur-
gery.36–38 True retinal folds involve only the neurosensory
retina and can be partial—inner or outer retina—or full
thickness. Conversely, chorioretinal folds involve the RPE
and the choroid also and occur mostly in case of globe
hypotony after RRD repair (Figure 4). In myopic eyes,
chorioretinal folds should not be confused with RPE
humps, which are RPE elevations over remnants of large
choroidal vessels in a thinned choroid.39
Full-thickness retinal folds involve all retinal layers and
can occur anywhere in areas of the previously detached
retina. Retinal folds develop as early as the first days after
the surgery and can be detected on indirect ophthalmoscopy
as straight or curvilinear retinal wrinkling over an intact
choroid. Structural cross-sectional OCT is very useful in
confirming the diagnosis and distinguishing from other
types of folds. When located in the periphery, retinal folds
are relatively asymptomatic and rarely require treatment,
unless associated with persistent or recurrent retinal detach-
ment. Contrariwise, full-thickness retinal folds involving
the macula often cause significant visual impairment and
prompt surgical correction is required to restore the visual
function (Figure 5).40 There is a paucity of studies on this
topic, and their true incidence can only be estimated for the
existing case series.38 In a large series of primary RRD
repair with scleral buckling, retinal folds were reported in
2.8% of eyes.41 Risk factors included the use of intraocular
gas tamponade, recent RRD, large scleral buckles, bullous
and superior detachments, incomplete drainage of SRF, and
retinal detachment running through the macula.40
Coppola et al. 5

Figure 5.  Full-thickness retinal fold. Structural cross-sectional OCT shows a full-thickness retinal fold, appearing as folding of all
layers of the neurosensory retina over a normal RPE and choroid.

Figure 6.  Outer retinal folds. Outer retinal folds are creases of the retina found after successful retinal detachment surgery. On
structural cross-sectional OCT, they appear as hyperreflective vertical (arrows) or roundish (arrowhead) lesions involving the
outermost retinal layers and protruding into the outer nuclear layer.

Outer retinal folds (Figure 6) involve the outer retinal
layers and regress spontaneously with no need for any
additional surgical intervention.42 Although the distinction
between outer retinal folds and full-thickness retinal folds
may be challenging on funduscopic examination, it is
straightforward with structural cross-sectional OCT imag-
ing.37 Outer retinal folds have been observed after peeling
of an adherent ERM also, in case of a transient retinal
detachment in the macular region.43
Finally, inner retinal folds involve inner retinal layers
and spare the outer retina.38 Inner retinal folds can be asso-
ciated with an ERM, whose contraction over time gener-
ates tractions and wrinkles over the superficial retina that
eventually result in the formation of complete folds.
Surgical correction of the ERMs can be required to flatten
inner retinal folds.
Tamponading agents
Subretinal perfluorocarbon liquids. Perfluorocarbon liquids
(PFCLs) have become a valuable tool for vitreoretinal sur-
geons due to their favorable properties, including high spe-
cific gravity, low surface tension and viscosity, optical
clarity and transparency, and immiscibility with other
organic fluids (water, blood).44
Despite the success, PFCL injection has been associ-
ated with a considerable number of complications, includ-
ing difficult removal, migration, and retention in the
subretinal space, toxic damage to the retina and RPE, and
combination with other tamponades as silicone oil creating
sticky bubbles.45–47
PFCLs can gain access to the subretinal space through
retinal breaks or retinotomies, which represent important
6 European Journal of Ophthalmology 00(0)
Figure 7.  Subretinal perfluorocarbon liquid (PFCL). Bubbles of PFCL on structural cross-sectional OCT appear as non-reflective
uniform cysts, covered by a thin bridge-shaped roof of retinal nerve fibers.
risk factors, especially if large size.48 Other predisposing
factors include the presence of tractions on retinal breaks
and peeling of membranes under PFCLs.
Strategies used to reduce the risk of subretinal migra-
tion of PFCLs include avoidance of formation of multiple
bubbles when injecting PFCLs into the vitreous chamber,
low infusion pressure, and meticulous removal of PFCLs.49
Subretinal PFCL may be missed intraoperatively, due to
turbulent fluidics and poor visualization in complex cases.
On the other hand, it is easily identified after the surgery
on ophthalmoscopy. On structural cross-sectional OCT,
subretinal bubbles of PFCLs appear as non-reflective uni-
form cysts, covered by a thin bridge-shaped roof of retinal
nerve fibers. The OCT also aids in assessing the integrity
of the retina, the photoreceptors, and the RPE next to
PFCL bubbles (Figure 7).50 Rupture of the retinal over
PFCL bubble is a rare event but can lead to the formation
of full-thickness retinal holes.51
When trapped under the macula, retained PFCLs can
cause an absolute scotoma; this inconvenience may require
prompt surgical aspiration. Similarly, extramacular PFCLs
gradually approaching the fovea represent an indication
for removal, as PFCL tends to leave an atrophic scar along
its path.52 In the remaining cases, a careful observational
strategy can be adopted.53 Surgical removal may particu-
larly benefit from intraoperative OCT, which helps in visu-
alizing the exact location of the retained PFCL, assisting
the surgical steps, and confirming the complete removal of
the bubble.54 After the removal of PFCLs, partial visual
recovery can be obtained. However, areas of RPE atrophy
correspond to irreversible visual loss.47
Macular alterations in silicone oil.  Silicone oil is a common
intraocular tamponade after vitreoretinal surgery for com-
plicated or recurrent cases of RRD. Due to its chemical
proprieties, silicone oil prevents the passage of fluid
through the retinal breaks and offers structural support
until the retina is steadily reattached. Emulsification of
silicone oil, elevated intraocular pressure, cataract, and
retinal toxicity represent its main side effects. OCT imag-
ing of eyes filled with silicone oil is possible, thanks to the
high optical penetration of the light beam; the interface
between fluid and silicone oil appears as a hyperreflective
demarcation line, with a prefoveal fluid pocket recogniz-
able in some cases (Figure 8).55 Macular edema and mac-
ular thinning can be observed in eyes filled with silicone
oil; its removal can reverse these conditions, restoring
physiological foveal profile.56 If macular thinning persists
even after removal, a poor visual outcome should be
expected.57
Thanks to the advanced automated OCT software, the
thickness of each singular macular layer can be calculated.
Using this tool, a significant retinal thinning has been
identified in the ganglion cell layer, the outer plexiform
layer, and the outer nuclear layer after removal of the sili-
con oil, oppositely to gas tamponade, which did not cause
any significant change in retinal layers thickness.57
Silicone oil emulsification appears as hyperreflective bub-
bles or dots, sometimes with hyperreflective tails on struc-
tural B-scan.58 Usually, these lesions remain superficial;
deeper penetration is associated with significant disorgani-
zation of retinal architecture, such as that observed in areas
of retinectomies. Although recognition is not easy, silicone
Coppola et al. 7
Figure 8.  Macular alterations due to silicone oil. Structural cross-sectional OCT shows the hyperreflective interface between fluid and
silicone oil (arrows). Macular thinning (top panel) and macular edema (bottom panel) can be observed in eyes filled with silicone oil.
oil emulsification has pivotal prognostic importance, as its
persistence may influence the final functional outcome. In
fact, persistent silicon oil emulsification bubbles have
been related to unexplained visual loss after tamponade
removal; in these patients, microcystic macular changes in
the inner nuclear layer and focal retinal nerve fiber layer
loss, similar to those found in various optic neuropathies
associated with retrograde synaptic degeneration, have
been found.59 The explanation of local toxicity of persis-
tent silicon oil emulsification bubbles derives from histo-
logical specimens,60 which demonstrated that the presence
of silicone oil vacuoles could promote chronic inflamma-
tion locally, subsequent cell damage, apoptosis, and func-
tional impairment. In this view, an accurate differential
diagnosis of the possible causes of intraretinal cysts should
be carried out.61 Early removal of silicone oil is mandatory
to reduce the chance of developing retinal toxicity.
However, even an early removal might not be able to
reverse all these abnormalities, suggesting that risks and
benefits should be carefully balanced when planning to use
silicone oil in retinal reattachment surgery.
Macular changes
Epiretinal membrane (ERM).  ERM formation is a common
event after surgery for RRD and is regarded as a macular
manifestation of proliferative vitreoretinopathy (PVR).
Although ERM may also occur after ab externo techniques
of vitreoretinal surgery, as scleral buckling, its incidence is
higher in eyes treated with pars plana vitrectomy, with an
estimated prevalence of 6%–35%.62
ERM formation may limit visual recovery as its con-
traction causes significant retinal distortion. Second sur-
gery for membrane peeling is occasionally required, with
increased morbidity and costs. Although fundus examina-
tion can be suggestive of ERM presence, OCT has become
an important test for the diagnosis, staging, and follow-up
of this condition.63 Most of the OCT features of ERMs sec-
ondary to retinal detachment are not dissimilar to idio-
pathic ERMs. In both cases, preretinal hyperreflective
bands, obliteration of the foveal pit, presence of ectopic
inner foveal layers, disorganization of the discrete retinal
layers, and alterations in the central foveal bouquet (i.e.
cotton ball sign, foveolar detachment, acquired vitelliform
lesions) can be recognized with different combina-
tions.63–65 Conversely, compared to primary ERMs, sec-
ondary membranes tend to be more focal and have
fingerlike projections, derived from tissue strands extend-
ing from the inner retinal surface.
The pathogenesis of ERMs following RRD repair
involves the migration of RPE and inflammatory cells
from the peripheral breaks toward the premacular internal
limiting membrane (ILM) surface, their proliferation and
activity as a scaffold for glial expansion.66 In the attempt to
reduce the incidence of ERM occurrence, several authors
have proposed a prophylactic ILM peeling during vitrec-
tomy for RRD, with favorable outcomes.67
Proliferative vitreoretinopathy (PVR). PVR is one of the
most sight-threatening complications of RRD. It consists
of the development of retinal folds, ERMs, and subreti-
nal fibrosis that can lead to re-detachment (Figure 9). Its
incidence has been estimated between 5% and 10% of
successfully treated RRD cases, and the development
is more frequent in the first 6 months after the primary
surgery.68–71 Risk factors include preoperative PVR, apha-
kia, large retinal breaks, extensive RRD, high aqueous
flare, and reinterventions.68,72,73
8 European Journal of Ophthalmology 00(0)
Figure 9.  Proliferative vitreoretinopathy (PVR). Structural cross-sectional OCT shows tractional retinal folds, epiretinal
membranes, cystic spaces, and disorganization of the retinal layers.
OCT examination of eyes with PVR reveals wrinkling of
the inner retinal surface with confluent full-thickness retinal
folds. More advanced cases can develop subretinal bands,
which appear as hyperreflective tubular structures.74
Cystoid macular edema. Postoperative cystoid macular
edema (CME) is the most common complication responsi-
ble for incomplete visual recovery following RRD repair;
it occurs in approximately 4%–11% of operated eyes.75,76
Although the diagnosis of CME has traditionally been
based on fluorescein angiography, OCT has emerged as an
alternative non-invasive tool in the diagnosis and manage-
ment of CME.
Already Gass stated in 1972 that CME can be frequently
seen after RRD surgery in aphakic patients and is occa-
sionally a cause of visual loss after scleral buckling.
Subsequently, Ryan77 documented two cases of decreased
vision caused by CME after scleral buckling in phakic
eyes. Cleary and Leaver78 collected 66 eyes after surgical
reattachment of macula-off detachments and found that
decreased vision was usually accompanied by a definable
CME. Meredith et al.79 found CME in 25% of the phakic
eyes and 40% of the aphakic eyes after successful scleral
buckling surgery.
Conversely, the prevalence after pneumatic retinopexy
has been reported as low as 8% of cases.80
Lai et al.81 investigated the risk factors associated with
CME after scleral buckling, including older age, more
extended RRD, macular detachment, and external drain-
age. The authors suggested that external drainage should
be used with caution in older patients with extensive RRD.
The exact etiopathogenesis of CME after RRD is
unclear, but ocular inflammation plays a primary role,
especially after the trauma of cryotherapy or SRF drain-
age.82 On the contrary, CME has not been related to the
preoperative macular status or duration of RRD.83
Nowadays, the incidence of CME has dramatically
reduced, thanks to the usage of topical nonsteroidal anti-
inflammatory drug (NSAID) prophylactically before the
surgery.84 Furthermore, obvious cases spontaneously
regress in up to 76% of cases within 2 years. In non-resolv-
ing cases, topical corticosteroid and NSAID, systemic
acetazolamide, and intravitreal steroids have been used,
with different rates of success.85,86
Macular hole (MH). The development of full-thickness
MH (FTMH) following surgery for RRD is an uncommon
event, occurring in the 0.2%–1.9% of cases.87–90
Because FTMH is traditionally thought to be caused by
vitreo-foveal tractions, and vitrectomy implies the removal
of the posterior cortical vitreous, the pathogenesis of FTMH
after RRD surgery is hard to explain. However, Brown91
Coppola et al. 9
initially described the development of MH after scleral
buckling, and other authors have later noted this complica-
tion after pneumatic retinopexy92 and vitrectomy.93
Proposed mechanisms of formation of FTMH include
persistent vitreo-foveal traction or rupture of large foveal
cysts in the setting of postsurgical CME.87 Although MH
can be identified at the fundus examination, the visualiza-
tion, monitoring, and staging are best carried out by means
of OCT imaging.94 On OCT, the FTMH appears as an inter-
ruption of all retinal layers in the foveal region and is staged
depending on its size, in small (⩽250 µm), medium (>250
and ⩽400 µm), and large (>400 µm).94 FTMH secondary
to RRD repair has been associated with ERM, macula-off
detachment, recurrent detachment, and high myopia.95
FTMH closure usually requires a second surgery and
has limited visual prognosis even in cases with satisfactory
anatomic success.95 Moshfeghi et al. have reviewed 12
cases of FTMH after scleral buckling or pneumatic retin-
opexy; the median time to MH diagnosis after RRD repair
was 3.4 months. The authors reported that eight of the
eight eyes (100%) undergoing surgical repair with pars
plana vitrectomy with long-acting gas tamponade achieved
macular reattachment with a median of 3.5 lines of visual
improvement after 14.8 months of follow-up.96
Despite being rare, lamellar MH also can develop after
vitrectomy.97 OCT imaging allows this entity to be distin-
guished from FTMH easily, and this distinction has high rel-
evance in the therapeutic management of the condition.97
Conclusion
In conclusion, OCT is a useful tool in the management of
patients treated for RRD. Some OCT findings may not be
evident on fundus examination, such as subtle slivers of
persistent SRF and macular alterations related to silicone
oil. In these cases, the use of OCT can provide novel
details, guiding clinical management and giving insights
for the visual prognosis. Other findings, such as subretinal
blebs, ERMs, and CME, despite being visible on fundu-
scopic examination, may be better assessed and followed
with the aid of OCT. All these elements contribute to sup-
port the importance of tomographic assessment in the fol-
low-up of eyes treated for vitreoretinal conditions. Recent
developments of OCT technologies, such as intraoperative
OCT, intraocular OCT, and OCT angiography, have shown
promising results, demonstrating to be reliable and repro-
ducible when correctly analyzed.98–101 These novel tech-
niques hopefully will be integrated into the clinical practice
and might reveal soon additional information able to guide
clinicians in the management of RRD patients.
Declaration of conflicting interests
The author(s) declared the following potential conflicts of
interest with respect to the research, authorship, and/or publi-
cation of this article: G.Q. has the following disclosures:
Allergan, Alimera, Amgen, Bayer, KHB, Novartis, Roche,
Sandoz, Zeiss; Allergan, Alimera, Bausch and Lomb, Bayer,
Heidelberg, Novartis, Zeiss. F.B. has the following disclo-
sures: Allergan, Alimera, Bayer, Farmila-Thea, Schering
Pharma, Sanofi-Aventis, Novagali, Pharma, Hoffmann-La
Roche, Genetech, Novartis. The other authors have nothing to
disclose. A.M., M.V.C., A.R., C.G., and G.Q. confirm they are
editors of this journal and they were not involved in the peer
review process for this paper.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iDs
Maria Vittoria Cicinelli https://orcid.org/0000-0003-2938
-0409
Giuseppe Querques https://orcid.org/0000-0002-3292-9581
Francesco Bandello https://orcid.org/0000-0003-3238-9682
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