Premacular membrane formation after scleral buckling for primary rhegmatogenous retinal detachment: prospective study and pathophysiological insights.
PURPOSE
To investigate the incidence, clinical features and risk factors of premacular membrane (PMM) formation after primary rhegmatogenous retinal detachment (RRD) repair with scleral buckling (SB) alone.


METHODS
This institutional, prospective and consecutive case series included phakic eyes with RRD, treated with SB alone within 7 days from the occurrence of symptoms, with a follow-up of 6 months. Spectral-domain optical coherence tomography images were reviewed. The association of PMM development and morphology with preoperative and intraoperative RRD features was analysed.


RESULTS
Ninety-two patients with a mean age of 56±13 years completed the 6 months follow-up period. Postoperatively, eyes with any PMM stage were 30 out of 92 (32.6%) at 1 month and 47 out of 92 (51,1%) at both 3 months and 6 months. Over the follow-up period, 17 out of 47 PMMs (36.2%) progressed to later stages. Progression of PMMs to later stages were observed only in RRDs involving the macular region (17 out of 35 eyes, 48.5%), while none of the PMMs in macula-sparing detachments progressed to later stages (p=0.020). The risk factors significantly associated with postoperative new onset of PMM were preoperative RRDs involving the macular region (p=0.001), cryopexy time (p=0.045), presence of horseshoe tears (p=0.003), worse preoperative visual acuity (p=0.004) and subretinal fluid drainage (p=0.047).


CONCLUSION
The incidence of postoperative PMM formation after RRD repair with SB alone was high. In retinal detachments involving the macular region PMM were more severe, tending to anatomical progression and functional deterioration. Activation of foveal Müller cell in detachments involving the macula may be a key factor in PMM progression.
['Cacioppo|Viviana|V|', 'Govetto|Andrea|A|0000-0003-2192-810X', 'Radice|Paolo|P|', 'Virgili|Gianni|G|', 'Scialdone|Antonio|A|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D005260:Female D005500:Follow-Up Studies D006801:Humans D015994:Incidence D007558:Italy D008266:Macula Lutea D008297:Male D008875:Middle Aged D011183:Postoperative Complications D011446:Prospective Studies D012163:Retinal Detachment D012591:Scleral Buckling D041623:Tomography, Optical Coherence D014792:Visual Acuity D055815:Young Adult
Premacular membrane scleral buckling rhegmatogenous retinal detachment Müller cells ectopic inner foveal layers.