Foveal microstructure and visual acuity after retinal detachment repair: imaging analysis by Fourier-domain optical coherence tomography.
OBJECTIVE
To evaluate foveal microstructural changes in eyes with anatomically successful repair of rhegmatogenous retinal detachments (RRDs).


METHODS
Retrospective, consecutive, observational case series.


METHODS
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.


METHODS
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.
Wakabayashi
Taku
T
Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan.
Oshima
Yusuke
Y
Fujimoto
Hisataka
H
Murakami
Yoko
Y
Sakaguchi
Hirokazu
H
Kusaka
Sunji
S
Tano
Yasuo
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D003452:Cryosurgery; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D005583:Fourier Analysis; D005584:Fovea Centralis / Q000473:pathology*; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies; D012591:Scleral Buckling; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy; D055815:Young Adult
D005466:Fluorocarbons; C042852:perflutren; D013459:Sulfur Hexafluoride