Macular perfusion analysis using optical coherence tomography angiography post rhegmatogenous retinal detachment repair: a systematic review and meta-analysis

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BACKGROUND: Evaluating rhegmatogenous retinal detachment (RRD) repair traditionally focuses on anatomical reattachment and visual acuity. Understanding macular perfusion changes post-repair offers a more comprehensive assessment. Optical coherence tomography angiography (OCTA) non-invasively visualizes retinal microvasculature, enabling detailed perfusion analysis. METHODS: Our protocol was registered (PROSPERO CRD42024533072). We searched PubMed, Scopus, ScienceDirect, and Cochrane databases (from inception to November 2024) for studies comparing OCTA parameters between post-repair RRD eyes and controls. Analyzed parameters included foveal avascular zone (FAZ) area, foveal (FVD) and parafoveal vascular density (PFVD), choriocapillaris (CC) perfusion, and best-corrected visual acuity (BCVA). Data were analyzed for macula-ON and macula-OFF groups using a random-effects model. RESULTS: , 95% CI: 0.04-0.19). FVD showed no significant differences in either group. PFVD demonstrated a significant reduction in DCP for both macula-ON (- 1.38%, 95% CI: - 2.72 to - 0.05) and macula-OFF (- 2.83%, 95% CI: - 5.04 to - 0.63) groups. CC perfusion density showed a significant reduction post-repair (- 2.39%, 95% CI: - 4.56 to - 0.22). Postoperative BCVA improved significantly in macula-OFF cases (0.79 logMAR, 95% CI: 0.37-1.21) but showed no significant change in macula-ON cases. CONCLUSIONS: Despite successful anatomical repair of RRD, persistent alterations in macular perfusion parameters were observed, particularly in the macula-OFF group. The enlarged FAZ area and reduced PFVD and CC perfusion density suggest lasting changes in the retinal microvasculature post-repair. However, significant improvement in BCVA, especially in macula-OFF cases, indicates that functional recovery may occur despite these vascular changes. These findings highlight the need for comprehensive assessment beyond isolated perfusion metrics when evaluating surgical success in RRD repair.

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