Korean J Ophthalmol.  2013 Jun;27(3):178-185. 10.3341/kjo.2013.27.3.178.

Structural Recovery of the Detached Macula after Retinal Detachment Repair as Assessed by Optical Coherence Tomography

• Joe SG
• Kim YJ
• Chae JB
• Yang SJ
• Lee JY
• Kim JG
• Yoon YH

• KMID: 1798055
• DOI: http://doi.org/10.3341/kjo.2013.27.3.178

Abstract

PURPOSE
To investigate correlations between preoperative and postoperative foveal microstructures in patients with macula-off rhegmatogenous retinal detachment (RRD).
METHODS
We reviewed the records of 31 eyes from 31 patients with macula-off RRD who had undergone successful re-attachment surgery. We analyzed data obtained from complete ophthalmologic examinations and optical coherence tomography (OCT) before and 9 to 12 months after surgery. All postoperative OCT measurements were taken with spectral-domain OCT, but a subset of preoperative OCT measurements were taken with time-domain OCT.
RESULTS
The mean duration of macular detachment was 15.5 +/- 15.2 days, and mean preoperative best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution) was 1.03 +/- 0.68. Preoperative visual acuity was correlated with retinal detachment height (p < 0.001) and the existence of intraretinal separation (IRS) along with outer layer undulation (OLU) (p = 0.022), but not with macula-off duration. The final BCVA was significantly correlated with integrity of the junction between the photoreceptor inner and outer segments (IS/OS) combined with the continuity of external limiting membrane (ELM) (p = 0.025). The presence of IRS and OLU on a detached macula were highly correlated with the final postoperative integrity of the IS/OS junction and the ELM (p = 0.017).
CONCLUSIONS
Eyes preoperatively exhibiting IRS and OLU showed a higher incidence of disruption to the photoreceptor IS/OS junction and the ELM at final follow-up. Such a close correlation between preoperative and postoperative structural changes may explain why ultimate visual recovery in such eyes is poor.

Keyword

Intraretinal layer separation; Junction between the photoreceptor inner and outer segments; Optical coherence tomography; Outer retinal layer undulation; Rhegmatogenous retinal detachment

MeSH Terms

Adolescent
Adult
Female
Fovea Centralis/*pathology/*surgery
Humans
Macula Lutea/pathology/surgery
Male
Middle Aged
*Recovery of Function
Retinal Detachment/*pathology/*surgery
Retrospective Studies
*Tomography, Optical Coherence
Young Adult

Figure

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  Fig. 1 (A) time-domain optical coherence tomographic (TD-OCT) image of macula-off rhegmatogenous retinal detachment reveals retinal detachment (RD); the height of such detachment and the extent of RD. (B) A TD-OCT image of macular-off rhegmatogenous retinal detachment shows intraretinal separation (IRS) and outer layer undulation (OLU). (C) An image acquired using spectral-domain optical coherence tomography (SD-OCT). IRS and OLU are relatively large structural changes. Thus, TD-OCT can identify such changes as reliably as can SD-OCT. (D) An SD-OCT image shows disruption of the junction between the photoreceptor inner and outer segments (IS/OS) and an external limiting membrane (ELM); the image was acquired on postoperative follow-up. All parameters were assessed from the central 3-mm diameter area.

• 

  Fig. 2 (A) No significant difference in macula-off duration was evident between eyes with both intraretinal separation (IRS) and outer layer undulation (OLU) (p = 0.28). (B) Eyes with both IRS and OLU had a greater height of retinal detachment (RD) than did eyes lacking both IRS and OLU (p = 0.002). (C) Eyes with both IRS and OLU had lower best-corrected visual acuity (BCVA) values than eyes without either feature (p = 0.022). (D) Eyes with an intact junction between the photoreceptor inner and outer segments (IS/OS) and an intact external limiting membrane (ELM) showed better postoperative BCVA values than did eyes in which the IS/OS junction and the ELM were both damaged (p = 0.025). The solid lines indicate the medians and the long dashes the averages. logMAR = logarithm of the minimum angle of resolution.

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  Fig. 3 Eyes with both intraretinal separation (IRS) and outer layer undulation (OLU) exhibited lower integrity of both junction between the photoreceptor inner and outer segments and the external limiting membrane (p = 0.017). PHRc = photoreceptor complex including external limiting membrane and junction between the photoreceptor inner and outer segments.

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