THAY ĐỔI THỊ LỰC, ĐẶC ĐIỂM OCT VÕNG MẠC VÀ TÍNH KHẢ THI VIỆC SỬ DỤNG IOL CAO CẤP CHO BỆNH NHÂN PHẪU THUẬT BONG VÕNG MẠC

Abstract

Purpose: To evaluate functional outcome and changes in optical coherence tomography (OCT) after for retinal detachment (RD) surgey (pars plana vitrectomy – PPV or scleral buckle) and propose IOL selection: monofocal or multifocal IOL selection. Methods: This retrospective study included 85 eyes with successful anatomical outcome after PPV for RD. Data on demographics, preoperative and postoperative visual acuity (VA), and OCT findings at 24 months post-PPV were collected. OCT parameters included central macular thickness, ganglion cell complex (GCC), ellipsoid zone integrity (ISOS), presence of epiretinal membrane, macular edema, sub-retinal fluid (SRF), macular hole, proliferative vitreal retinopathy (PVR) and macula on/off status. The correlation between these OCT features and visual outcomes, as well as the success of premium IOL implantation, was analyzed. Results: The mean baseline VA was 1.55 (SD = 0.96), and VA at 24 months (VA_24) was 0.38 (SD = 0.39). 61(71.8%) eyes monofocal IOL, 11(12.9%) eyes multifocal IOL and 13(15.3%) eyes phakia. The correlation coefficient: VA_24 and ISOS was 0.8, (p < 0.05). VA_24 and GCC was -0.2(p = 0.062). VA_24 and type of IOL was -0.137 (p = 0.21). The R-squared values for the multiple linear regression model predicting VA_24 was approximately 0.59. Significant predictors included ISOS (0.52), baseline VA (-0.009), PVR (0.01), macula on/off (0.05), resolution of SRF (-0.01), macular edema (0.118), macular hole (0.16), and duration of RD (0.001). Conclusion: The integrity of the IS/OS junction is a crucial factor in visual recovery following retinal detachment surgery. Macula-off detachments pose a greater risk of IS/OS disruption, which correlates with poorer visual outcomes, whereas macula-on detachments generally have a better prognosis due to the preservation of the IS/OS junction. Advanced imaging techniques like OCT are essential for postoperative monitoring to predict and evaluate visual recovery [1]. Patients with favorable OCT features post-PPV have better visual function may benefit from multifocal IOLs during subsequent cataract surgery.