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Premacular membrane formation after scleral buckling for primary rhegmatogenous retinal detachment: prospective study and pathophysiological insights
  1. Viviana Cacioppo1,
  2. Andrea Govetto1,
  3. Paolo Radice1,
  4. Gianni Virgili2,
  5. Antonio Scialdone1
  1. 1 Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, Milan, Italy
  2. 2 Ophthalmology Department, Careggi Hospital, University of Florence, Florence, Italy
  1. Correspondence to Dr Andrea Govetto, Department of Ophthalmology, Fatebenefratelli-Oftalmico Hospital, MilanMI 20121, Italy; a.govetto{at}


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.

  • Premacular membrane
  • scleral buckling
  • rhegmatogenous retinal detachment
  • Müller cells
  • ectopic inner foveal layers.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Asst-fbf-sacco institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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