Preretinal abnormal tissue before and after pars plana vitrectomy in macula-on rhegmatogenous retinal detachment: a multimodal imaging study

Purpose To quantitatively explore preretinal abnormal tissue (PAT) in macula-on rhegmatogenous retinal detachment (RRD) before and after surgery. Methods In this case-series study, PAT was detected by en-face optical coherence tomography images with custom slabs in eyes that underwent pars plana vitrectomy and SF6 for macula-on RRD. Main outcome measures were PAT area at baseline, 3-month and 6-month follow-up, and its relative change. Associations between PAT and foveal avascular zone (FAZ) at superficial capillary plexus (SCP), RRD area, retinal tear (RT) area and endolaser area were investigated. Results 36 macula-on eyes RRD were included in the analysis. Significant PAT growth was registered from baseline until 6 months (p<0.001). Baseline PAT area correlated with RT area (r=0.54, p=0.001). Significant correlation between relative change in PAT and relative change in FAZ SCP was found. The multivariable regression model showed a statistically significant association between Endolaser area (cm 2) and relative changes in PAT (p=0.004). Conclusions Our study found that despite good retinal reattachment, PAT proliferates over months with vascular changes. Endolaser area has a major influence on PAT growth, without impact on best-corrected visual acuity. Additional knowledge about pathophysiological mechanisms of growth could help understanding which surgical approach may limit PAT extension and future secondary epiretinal membrane. © Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.