Foveal Microstructure and Visual Acuity after Retinal Detachment Repair: Imaging Analysis by Fourier-Domain Optical Coherence Tomography
Presented in part at: the Annual Meeting of American Academy of Ophthalmology, November, 11–13, 2007, New Orleans, Louisiana.
Received 22 May 2008; received in revised form 3 October 2008; accepted 3 October 2008. published online 14 January 2009.
Purpose
To evaluate foveal microstructural changes in eyes with anatomically successful repair of rhegmatogenous retinal detachments (RRDs).
Design
Retrospective, consecutive, observational case series.
Participants
Fifty-three eyes of 51 consecutive patients with macula-on RRDs (15 eyes) or macula-off RRDs (38 eyes) after anatomically successful surgical repair.
Methods
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.
Main Outcome Measures
Images of the foveal microstructure obtained by FD-OCT and the BCVA measured on the same day.
Results
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.
Conclusions
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.
Financial Disclosure(s)
Proprietary or commercial disclosures may be found after the references.
Available online: January 14, 2009.
Department of Ophthalmology, Osaka University Medical School, Suita, Japan
Correspondence: Yusuke Oshima, MD, Department of Ophthalmology, Osaka University Medical School, 2-2 Yamadaoka, E-7, Suita, Osaka 565-0871, Japan
Manuscript no. 2008-630.
Financial Disclosure(s): Dr. Tano is a consultant and holds stock options in Optovue, Inc. No other authors have a proprietary interest or conflict of interest in any products mentioned in this article.
Supported in part by research grants from the Ministry of Education, Science and Culture, Tokyo, Japan.
ABSTRACT