Restoration of foveal thickness and architecture after macula-off retinal detachment repair (original) (raw)
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Foveal Microstructure and Visual Acuity after Retinal Detachment Repair
Ophthalmology, 2009
To evaluate foveal microstructural changes in eyes with anatomically successful repair of rhegmatogenous retinal detachments (RRDs). Retrospective, consecutive, observational case series. Fifty-three eyes of 51 consecutive patients with macula-on RRDs (15 eyes) or macula-off RRDs (38 eyes) after anatomically successful surgical repair. A microscopic fundus examination was conducted followed by Fourier-domain optical coherence tomography (FD-OCT) to assess the postoperative foveal microstructure. The correlation between the postoperative best-corrected visual acuity (BCVA) and microstructural findings at the fovea was evaluated. Images of the foveal microstructure obtained by FD-OCT and the BCVA measured on the same day. We obtained FD-OCT images a mean of 10.3+/-7.3 months (range, 1-25) postoperatively. Foveal anatomic abnormalities were detected in 33 eyes (62%); disruption of the junction between the photoreceptor inner and outer segments (IS/OS) in 23 eyes (43%), of which 9 eyes (39%) had a disrupted external limiting membrane (ELM); residual subretinal fluid in 6 eyes (11%), epiretinal membranes in 12 eyes (23%), and cystoid macular edema in 2 eyes (4%). Disruption of the photoreceptor IS/OS junction was observed only in macula-off eyes, whereas other microstructural abnormalities were observed in both macula-on and macula-off eyes. In preoperative macula-off eyes, the postoperative BCVA was significantly correlated with the integrity of the photoreceptor IS/OS and ELM signals detected by FD-OCT postoperatively (r=0.805; P<0.001). Of the 16 eyes followed by FD-OCT, the photoreceptor IS/OS junction was restored in 7 (64%) of the 11 eyes with a disrupted back-reflection line from the IS/OS junction, but without disrupted ELM signals at the initial examination. Of the 5 eyes with disrupted back-reflection lines from both IS/OS junction and ELM at the initial examination, the photoreceptor layer was not restored completely during the follow-up period in any eyes. After anatomically successful RRD repair, FD-OCT is a valuable, noninvasive tool for evaluating foveal microstructural changes. The integrity of the photoreceptor IS/OS junction and ELM signals detected by FD-OCT may account for visual restoration in patients with preoperative macula-off RRDs. Preservation of the ELM postoperatively may predict the subsequent restoration of the photoreceptor layer.
Journal of Ophthalmic and Vision Research, 2015
Purpose: To evaluate foveal microstructural changes and to determine its association with visual outcomes after reattachment of rhegmatogenous retinal detachments (RRDs) by scleral buckling (SB) or pars plana vitrectomy (PPV). Methods: Using spectral domain optical coherence tomography (SD-OCT), foveal microstructure in eyes with macula-off RRD were studied 1, 3, 6, 9, 12 and 15 months after PPV or SB and correlated with visual outcomes. Results: Forty-two eyes were included in the final analysis. Even with improved microstructural changes and normalization of retinal structures on OCT, final visual acuity was not correlated with microstructural changes in eyes undergoing PPV. In the SB group, final visual acuity was significantly correlated with an intact inner segment/outer segment (IS/OS) junction (P = 0.013). There was no significant correlation between final visual acuity and presence of subretinal fluid (SRF) in either group. Conclusion: After SB, eyes with an intact IS/OS junction had better final visual acuity. In the PPV group, there was no significant correlation between microstructural changes and visual acuity. The presence of SRF did not influence final visual acuity in both groups.
Investigative Ophthalmology & Visual Science, 2014
PURPOSE. Optical coherence tomography (OCT) was used to analyze the thickness of various retinal layers of patients following successful macula-off retinal detachment (RD) repair. METHODS. Optical coherence tomography scans of patients after successful macula-off RD repair were reanalyzed with a subsegmentation algorithm to measure various retinal layers. Regression analysis was performed to correlate time after surgery with changes in layer thickness. In addition, patients were divided in two groups. Group 1 had a follow-up period after surgery of up to 7 weeks (range, 21-49 days). In group 2, the follow-up period was >8 weeks (range, 60-438 days). Findings were compared to a group of age-matched healthy controls. RESULTS. Correlation analysis showed a significant positive correlation between inner nuclearouter plexiform layer (INL-OPL) thickness and time after surgery (P ¼ 0.0212; r 2 ¼ 0.1551). Similar results were found for the ellipsoid zone-retinal pigment epithelium complex (EZ-RPE) thickness (P ¼ 0.005; r 2 ¼ 0.2215). Ganglion cell-inner plexiform layer thickness (GCL-IPL) was negatively correlated with time after surgery (P ¼ 0.0064; r 2 ¼ 0.2101). For group comparison, the retinal nerve fiber layer in both groups was thicker compared to controls. The GCL-IPL showed significant thinning in group 2. The outer nuclear layer was significantly thinner in groups 1 and 2 compared to controls. The EZ-RPE complex was significantly thinner in groups 1 and 2 compared to controls. In addition, values in group 1 were significantly thinner than in group 2. CONCLUSIONS. Optical coherence tomography retinal layer thickness measurements after successful macular-off RD repair revealed time-dependent thickness changes. Inner nuclearouter plexiform layer thickness and EZ-RPE thickness was positively correlated with time after surgery. Ganglion cell-inner plexiform layer thickness was negatively correlated with time after surgery.
Journal of Ophthalmology, 2015
Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD.Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n=357); (2) macula-on patients with visual loss at the third month of follow-up (n=53) which were further subdivided in (3) phakic eyes (n=39); and (4) pseudophakic eyes (n=14).Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n=39phakic eyes;n=14pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combin...
2020
properly cited. Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD. Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes ( = 357); (2) macula-on patients with visual loss at the third month of follow-up ( = 53) which were further subdivided in (3) phakic eyes ( = 39); and (4) pseudophakic eyes ( = 14). Results. Fifty-three eyes (14.9%) had visual loss three months after surgery ( = 39 phakic eyes; = 14 pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant i...
Ophthalmologica
Purpose: To assess preoperative optical coherence tomography (OCT) findings of foveal-splitting retinal detachment (RD) and determine postoperative outcomes. Methods: Consecutive patients who underwent RD surgery over a 1-year period were included. Patients diagnosed with a detachment extending to the edge of the fovea on fundus examination (i.e., macula-On/Off) underwent macular OCT scanning. Visual acuity (VA) after 1 year of macula-On/Off, macula-On, and macula-Off eyes was compared. Results: A total of 85 eyes were included, 8 of which had a macula-On/Off RD. On preoperative OCT, all macula-On/Off RD eyes had foveal detachment extending beyond the foveal center over a median distance of 632 µm. Mean VA of the macula-On/Off eyes had improved from 20/160 to 20/40 at 1 year postoperatively (p = 0.035). The preoperative VA of macula-On/Off eyes was significantly better than macula-Off eyes (p = 0.032) and lower than macula-On eyes (p = 0.004). At 1 year, the VA of macula-On/Off eyes...
Long-Term Postoperative Structural and Functional Evaluation in Myopic Foveoretinal Detachment
International Journal of Ophthalmology and Clinical Research, 2021
Purpose: Avoidable severe visual sequelae are prevalent among highly myopic eyes. We analyzed the postoperative incidence of myopic traction maculopathy (MTM) progression and long-term postoperative structural and functional findings after macular surgery for myopic foveoretinal detachment (FRD). Methods: A retrospective, consecutive, comparative, interventional, one-surgeon, multicenter control case series was conducted on 35 highly myopic eyes of 31 patients who underwent fovea sparing internal limiting membrane removal technique for myopic FRD between October 2016 and April 2020. Long-term postoperative SD-OCT and functional follow-up evaluations with microperimetry, chromatic campimetry and multifocal electroretinography were performed. The main outcome was the incidence of surgical success and progression of myopic FRD. Results: The mean evolution time of myopic FRD was 6.2 ± 3.5 months. The mean follow up time was 23.9 ± 12.1 months. The mean time for the myopic FRD resolution was 5 ± 2.1 weeks. Using a paired-samples permutation test, we found that surgery was associated with a significant improvement in visual acuity: BCVA (in logMAR) decreased from 0.87 ± 0.15 pre-surgery to 0.48 ± 0.52 logMAR, with P = 0.00075. Thirty-two eyes (91.4%) showed resolved myopic FRD. Three eyes (8.5%) showed progression: Two (5.7%) developed a full-thickness macular hole, and one (2.8%) developed a macular hole retinal detachment. Postoperative test results revealed retinal sensitivity abnormalities in 10-2 and 30-2 visual-field examinations in 18 of 19 eyes (94.7%) examined; 16 of 17 eyes (94.1%) tested showed an abnormal response on microperimetry with a stable foveocentral fixation pattern, and 20 of 21 eyes (95.2%) tested showed a profound reduction in N1-and P1wave amplitudes. Conclusions: Results showed a high incidence of microstructural regression (91.4%) with low incidence of MTM structural progression after surgery (8.5%). Long-term structural and functional evaluations revealed an abnormal macula.
…, 2008
ObjectiveTo evaluate the morphologic changes in the macula of subjects with repaired macula-off retinal detachment (RD) using high-resolution Fourier-domain optical coherence tomography (FD OCT) and to perform functional correlation in a subset of patients using microperimetry (MP-1).DesignProspective observational case series.ParticipantsSeventeen eyes from 17 subjects who had undergone anatomically successful repair for macula-off, rhegmatogenous RD at least 3 months earlier and without visually significant maculopathy on funduscopy.MethodsFD OCT with axial and transverse resolution of 4.5 μm and 10 to 15 μm, respectively, was used to obtain rapid serial B-scans of the macula, which were compared with that from Stratus OCT. The FD OCT B-scans were used to create a 3-dimensional volume, from which en face C-scans were created. Among 11 patients, MP-1 was performed to correlate morphologic changes with visual function.Main Outcome MeasuresStratus OCT scans, FD OCT scans, and MP-1 data.ResultsStratus OCT and FD OCT images of the macula were obtained 3 to 30 months (mean 7 months) postoperatively in all eyes. Although Stratus OCT revealed photoreceptor disruption in 2 eyes (12%), FD OCT showed photoreceptor disruption in 13 eyes (76%). This difference was statistically significant (P<0.001, χ2). Both imaging modalities revealed persistent subretinal fluid in 2 eyes (12%) and lamellar hole in 1 eye. Among 7 subjects who had reliable MP-1 data, areas of abnormal function corresponded to areas of photoreceptor layer disruptions or persistent subretinal fluid in 5 subjects (71%); one subject had normal FD OCT and MP-1.ConclusionsPhotoreceptor disruption after macula-off RD repair is a common abnormality in the macula that is detected better with FD OCT than Stratus OCT. A good correlation between MP-1 abnormality and presence of photoreceptor disruption or subretinal fluid on FD OCT demonstrates that these anatomic abnormalities contribute to decreased visual function after successful repair.
Retina, 2011
Purpose: To investigate the influence of subfoveal fluid and foveal thickness on visual outcome in patients who underwent reattachment surgery for rhegmatogenous retinal detachment (RRD). Methods: This prospective study included 53 patients who were undergoing successful scleral buckling surgery for primary RRD. A thorough ophthalmologic examination including best-corrected visual acuity, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and optical coherence tomography scanning was performed preoperatively and during all subsequent follow-up visits at 1, 3, 6, 9, 12, and 24 months postoperatively. Results: Preoperative foveal thickness was significantly higher in the macula-off group (n = 38) compared with the macula-on group (n = 15) (P , 0.0001), whereas postoperative measurements were normal in both the groups. Linear mixed-model analysis revealed that persistent subfoveal fluid (P = 0.0004) was an independent predictor of a worse visual outcome after scleral buckling surgery for primary macula-off RRD, although the effect on visual outcome was small (0.1 logarithm of the minimal angle of resolution units). Moreover, increased preoperative foveal thickness was associated with a worse visual prognosis in macula-off RRD (P = 0.010). Conclusion: Persistent subfoveal fluid and increased preoperative foveal thickness were associated with a worse visual prognosis in macula-off RRD patients, albeit the effect of persistent subfoveal fluid was small and temporary.