Optical coherence tomography findings in the macula after treatment of rhegmatogenous retinal detachments with spared macula preoperatively

EVALUATION OF RETINAL DISPLACEMENT FOLLOWING PRIMARY SCLERAL BUCKLING FOR MACULA-INVOLVING RHEGMATOGENOUS RETINAL DETACHMENT

PURPOSE

To evaluate the incidence and degree of retinal displacement following scleral buckling surgery for macula-involving rhegmatogenous retinal detachment.

METHODS

Retrospective interventional case series comprised of patients treated with primary scleral buckling procedure without gas tamponade for macula-involving rhegmatogenous retinal detachment and imaged postoperatively with fundus autofluorescence imaging between June 1, 2016 and July 25, 2021. Clinical notes, operative reports, fundus autofluorescence photographs, and optical coherence tomography images were reviewed. The presence and degree of retinal displacement were recorded.

RESULTS

Twelve eyes of 11 patients were included. One (8%) eye with an epiretinal membrane demonstrated 0.1 mm of retinal displacement along the superior arcade and in the superotemporal periphery. The remainder of eyes (92%) did not show any identifiable signs of retinal displacement.

CONCLUSION

Retinal displacement does not seem to be a frequent complication of primary scleral buckling surgery for macula-involving rhegmatogenous retinal detachment.

Evaluation of the Effects of Silicone Oil on the Macula with Optical Coherence Tomography in Patients with Rhegmatogenous Retinal Detachment

Objectives:

The effects of silicone endotamponade duration on the macula were evaluated in patients with rhegmatogenous retinal detachment.

Materials and Methods:

Sixty-five eyes of 65 cases with rhegmatogenous retinal detachment that underwent pars plana vitrectomy and silicone endotamponade were included in the study. All cases were classified in three groups according to duration of silicone tamponade: ≤3 months, 3-6 months, and ≥6 months. All cases were evaluated at 1 week, 1 month, and 3 months after silicone injection, just before and at 1 month after silicone removal in terms of intraretinal pathologies in the macula by using spectral-domain optical coherence tomography (SD-OCT).

Results:

Sixteen (26.6%) of the patients were female and 49 (75.4%) were male. The mean age of the patients was 58.1±12.1 years (18-82); the mean follow-up time was 12.4±4 months (6-20). The mean duration of silicone tamponade was 6.7±2.3 months (2-12). In 26.6% of patients with ellipsoid zone/outer limiting membrane defect, a statistically significant improvement in reflectivity was detected after silicone oil removal (p=0.016). There was a significant increase in central foveal thickness after silicone removal in eyes with duration of silicone more than 3 months (p=0.003 for 3-6 months, p=0.006 for ≥6 months). The prevalence of cystoid macular edema before and after silicone removal was also significantly higher in the eyes with silicone duration of 6 months or longer (p<0.001).

Conclusion:

In eyes with silicone endotamponade, structural changes in the macula may differ according to the duration of silicone oil in the eye.

Multifactor analysis of delayed absorption of subretinal fluid after scleral buckling surgery

Background

The purpose of this study is to assess the absorption of subretinal fluid (SRF) after scleral buckling (SB) surgery for the treatment of rhegmatogenous retinal detachment (RRD). We also examined related factors that may affect the delayed absorption of SRF.

Methods

This retrospective study included patients who underwent successful SB surgery for the treatment of macula-off RRD and in which the retina was reattached after the surgery. The patients were categorized according to gender, duration, age, the number, and location of retinal breaks. Subfoveal choroidal thickness (SFCT), height of subretinal fluid (SRFH), and the choriocapillaris flow density (CCFD) within 3 × 3 mm macular fovea were included. Delayed absorption was determined by the SRF that remained unabsorbed for 3 months after the procedure. The endpoint was determined when the SRF could no longer be observed.

Results

A total of 62 patients (63 eyes) were enrolled. In 35 eyes (56.45%) SRF was completely absorbed and in 28 (43.55%) eyes delayed absorption of SRF in macular areas was observed at 3 months after surgery. A young age (< 35 years), inferior retinal breaks were associated with good outcomes by applying multivariable analysis on the rate of SRF absorption after SB instead of gender, the number of breaks, and duration (p < 0.05). CCFD was significantly different between the SRF group and the non-SRF group after SB (0.66 ± 0.04% vs 0.63 ± 0.05%, P < 0.05). SRFH showed a moderate positive correlation with SFCT (r_s = 0.462, p = 0.000), however, using binary logistic regression analysis it was determined that SFCT was not related to the absorption of the SRF.

Conclusions

The absorption of SRF after SB may be correlated with choriocapillaris flow density. Age and location of breaks are significant factors affecting the absorption of SRF. The duration of disease is an uncertain factor due to several subjective reasons.

Evolution of macular microvasculature and retinal layers alterations in patients with macula off retinal detachment after vitrectomy

PURPOSE

To examine the changes in retinal microvasculature in association with retinal layers' condition in patients with rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV).

METHODS

Participants in this study were 89 patients with macula off RRD, who were successfully treated with PPV and gas tamponade without internal limiting membrane peeling, in two centers. All participants underwent best corrected visual acuity (BCVA) measurement, slit-lamp examination, fundoscopy, spectral domain-optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA) at week 5, month 3 and month 6 postoperatively. The fellow untreated eyes were also examined and served as control data.

RESULTS

A statistically significant enlargement in foveal avascular zone (FAZ) in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), accompanied with a statistically significant thinning of inner retinal layers, was noticed 5 weeks postoperatively. These changes, namely FAZ enlargement and thinning of inner retinal layers, in the operated eyes compared to the fellow eyes, remained unchanged till month 6 postoperatively. BCVA improved significantly from week 5 to months 3 and 6 postoperatively. The improvement in BCVA was associated with the gradual ellipsoid zone (EZ) recovery from the first (week 5) till the last examination (month 6).

CONCLUSIONS

The FAZ enlargement in the operated eyes was accompanied with a statistically significant thinning in the inner retinal layers. Inter-correlation of BCVA and EZ integrity was noticed.

Natural history of persistent subretinal fluid following the successful repair of rhegmatogenous retinal detachment

AIM

To provide a detailed description of the natural history of persistent subretinal fluid (SRF) after successful repair of rhegmatogenous retinal detachment (RRD) and its association with visual outcome.

METHODS

This was a prospective long-term follow-up for eyes undergoing scleral buckling (SB) surgery for macula-off RRD. Examinations were carried out preoperatively and postoperatively at 1, 3, 6, 9 and 12mo, until persistent SRF had completely resolved. One month postoperatively, optical coherence tomography (OCT) was used to classify SRF into three patterns: bleb-like loculated (BL), shallow-diffused (SD), and multiple blebs (MB). Serial OCT imaging was used to evaluate morphological changes in SRF until its complete disappearance. Patients were divided into two groups depending on the presence or absence of persistent SRF.

RESULTS

A total of 59 patients (59 eyes) were included. There were no statistical differences between two groups at baseline, except for the proportion of patients with high myopia and a younger age. One month after surgery, OCT detected persistent SRF in 49 eyes (83.1%). The 3 morphological patterns of SRF were observed in 27 eyes (55.1%) with BL, 13 eyes (26.5%) with SD, and 9 eyes (18.4%) with MB. The mean time for complete absorption differed significantly across the three SRF patterns (F=8.097, P=0.001), which was 8.8±6.1, 20.1±12.1, and 16.7±10.2mo in BL, SD, and MB, respectively. In 9 of the 13 eyes with SD, the pattern transformed into MB type. In cases involving MB, the size and number of blebs decreased gradually until they had been completely absorbed. Eyes with persistent SRF were more likely to demonstrate disruption of the ellipsoid zone (49.0% vs 10%, P=0.034). The final best-corrected visual acuity of two groups was 0.37±0.11 (with SRF) vs 0.34±0.12 (without SRF) logMAR (P=0.499), respectively.

CONCLUSION

High preoperative myopia and younger age are associated with persistent SRF. BL is the most commonly observed pattern with the shortest duration and gradually disappeared. Most cases involving SD SRF transform into MB type during resolution. The size and number of the MBs decrease gradually until they were completely absorbed. The absence of persistent SRF may contribute to slow visual recovery in the short-term but does not influence the final visual outcome.

Efficacy of intravitreal dexamethasone implant for the treatment of macular oedema after pars plana vitrectomy for rhegmatogenous retinal detachment: long-term outcomes

Purpose: To investigate the efficacy and safety of intravitreal dexamethasone implant as initial and only treatment for macular oedema after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).Methods: This study included 14 patients, who were diagnosed with macular oedema after PPV for RRD and who were treated with intravitreal dexamethasone implant. Patients were examined at the time of macular oedema diagnosis (baseline) and 1, 6 and 12 months after treatment, using best corrected visual acuity (BCVA) measurement and optical coherence tomography (OCT).Results: The mean BCVA at baseline was 0.72 ± 0.29 logMAR and improved significantly to 0.37 ± 0.21, 0.42 ± 0.19 and 0.35 ± 0.22 logMAR at month 1, 6 and 12 after treatment with dexamethasone implant. The mean central retinal thickness (CRT) was 623 ± 142 μm at baseline and decreased significantly to 339 ± 163 μm, 428 ± 131 μm and 356 ± 147 μm at month 1, 6 and 12 after treatment. Total resolution of macular oedema was observed in 10 out of 14 patients (71.4%) at month 12. Ellipsoid zone was intact in 71.4% of patients at the end of the follow-up, while 71.4% of patients received only one implant until the end of the 12-month follow-up. No adverse events were observed.Conclusions: Intravitreal dexamethasone implant was found to be effective and safe as initial treatment for macular oedema after PPV for RRD.

Influence of submacular fluid on recovery of retinal function and structure after successful rhegmatogenous retinal reattachment

Purpose

To determine the influence of residual submacular fluid (SMF) on the recovery of function and structure of the retina after successful rhegmatogenous retinal detachment (RRD) reattachment.

Methods

We reviewed the medical records of all patients who had undergone successful RRD repair by scleral buckling (SB) surgery or by pars plana vitrectomy (PPV) from March 2011 to August 2014. Spectral-domain optical coherence tomographic images of the macular regions were used at 1, 2, 3, 6, 9, and 12 months following the surgery. The best-corrected visual acuities (BCVA) were evaluated at the same times.

Results

The eyes with a macula-off RRD that were treated by SB surgery had a significant higher incidence of residual SMF (52%) than those treated by PPV (6.8%; P <0.001). Nevertheless, the postoperative BCVA was significantly improved in the eyes that had undergone SB surgery (P = 0.007). The postoperative BCVAs were not significantly different between the groups in which the SMF was absorbed (12 eyes) and not absorbed (13 eyes) within 1 month after the SB surgery. The photoreceptor outer segment length and the presence of a foveal bulge were not significantly different between these two groups at 12 months. Multiple regression analyses showed that the presence of a foveal bulge (β = 0.531, P = 0.001) and the duration of the retinal detachment before surgery (β = 0.465, P = 0.002) but not the duration of the SMF were independent factors significantly correlated with the final BCVA.

Conclusions

These results suggest that the postoperative residual SMF does not significantly disrupt the functional and structural recovery of eyes with macula-off RRD treated by SB surgery.

Multiple subretinal fluid blebs after pars plana vitrectomy for rhegmatogenous retinal detachment repair

PURPOSE

To investigate the incidence of and clinical risk factors for multiple subretinal fluid (SRF) blebs after pars plana vitrectomy (PPV).

METHODS

This study examined patients who underwent PPV (25- or 27-gauge) to repair a primary rhegmatogenous retinal detachment (RRD). Clinical characteristics, including age, sex, axial length, symptom duration, and postoperative best-corrected visual acuity (BCVA), were compared between eyes with and without multiple SRF blebs. Intentional drainage retinotomy and cryotherapy use were also performed. Main outcome measures were the effect of these parameters on multiple SRF bleb incidence 1 month after surgery.

RESULTS

A total of 108 eyes of 106 patients (76 men and 32 women; mean age = 58.9 ± 9.0 years) were included. Multiple SRF blebs were observed in 8 eyes (7.4%). Logistic regression analysis showed that creation of intentional drainage retinotomy and 27-gauge PPV are risk factors for the development of multiple SRF blebs. The number and size of blebs spontaneously decreased over time, and SRF had completely resolved in 5 eyes (62.5%) 1 year after surgery.

CONCLUSION

Multiple SRF blebs developed even after small gauge vitrectomy. The SRF did not affect postoperative BCVA and gradually absorbed without treatment.

Comparison of persistent submacular fluid in different preoperative macular status after vitrectomy for rhegmatogenous retinal detachment

AIM

To compare the incidence of persistent submacular fluid (SMF) and visual outcome after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) in different preoperative macular status according to optical coherence tomography (OCT).

METHODS

A non-randomized, retrospective review was performed for patients who underwent successful PPV for RRD. OCT exams were taken preoperatively and 1mo after surgery, until SMF disappeared. According to the preoperative macular status on OCT, patients were divided into two groups: macula-off RRD (Group A) and macula-on RRD (Group B). In Group A, there were two subgroups: macula partly detached (Group A1) and macula totally detached (Group A2). The main outcome measures were the presence of SMF on OCT 1mo after surgery, and the preoperative and postoperative best corrected visual acuities (BCVA), among the different groups and depending on the presence or absence of persistent SMF.

RESULTS

A total of 139 eyes of 139 patients were included in the study. Persistent SMF at 1mo after surgery was 15.8% (22/139), all occurring in Group A (22/101); Group B had no SMF at 1mo after surgery (0/38, P=0.002). The incidence of persistent SMF at 1mo after surgery in Group A1 was 50% (14/28), and in Group A2 was 11.0% (8/73, P<0.001). Significant differences were shown between the presence and absence of persistent SMF on foveola-off RRD, the preoperative BCVA, the 1mo postoperative BCVA, and the degree of the BCVA improvement from 1mo postoperatively to the final follow-up (P<0.05). However, there were no significant differences in the final BCVA (P>0.05).

CONCLUSION

Persistent SMF after PPV for retinal detachment is associated with preoperative macular status. Macula-uninvolving RRD shows no persistent SMF after PPV. Macular partly detached RRD has a higher incidence of SMF than macula totally detached RRD after PPV. The persistence of SMF may be responsible for the delayed visual recovery, whereas there were no significant differences in the final visual acuity.

Visual Recovery after Primary Retinal Detachment Surgery: Biofeedback Rehabilitative Strategy

Purpose. To evaluate possible speeding up recovery time after retinal detachment (RD) surgery using biofeedback strategy. Methods. A total of 52 eyes were selected. After surgery, patients were divided into two groups: group A, including patients submitted to biofeedback with MP-1 strategy; group B, patients who received common care strategy. Biofeedback strategy was started 15 days after the suspension of cycloplegic eye drops in buckling procedure or after silicone oil removal in the vitrectomized eyes. Controls were scheduled at baseline and 6, 12, and 18 weeks. Results. At baseline, there was no significant difference in BCVA between groups (P = 0.4230). At the end of biofeedback treatment (WK 6) BCVA of group A was significantly better (P < 0.001) than group B and BCVA was still better in group A than group B at WK 12 (P = 0.028) and at WK 18 (P = 0.041). Conclusions. Visual recovery after RD surgery is still unclear, and it does not depend on entity of the RD. Our data demonstrate that in biofeedback group there was a significant recovery in visual performances that still remains evident after 3 months from the baseline.

Epiretinal membrane and cystoid macular edema after retinal detachment repair with small-gauge pars plana vitrectomy

PURPOSE

To evaluate the incidence rates of cystoid macular edema (CME) and epiretinal membrane (ERM) formation after uncomplicated primary 23-G and 25-G retinal detachment (RD) repair and to identify risk factors associated with postoperative CME and ERM formation.

METHODS

This was a consecutive interventional case series of 587 eyes that underwent one RD repair with 23-G or 25-G pars plana vitrectomy (PPV) with scleral buckling. Epiretinal membrane and CME were confirmed by optical coherence tomography (OCT) and fluorescein angiography (FA).

RESULTS

A total of 587 eyes with a mean follow-up of 404 days had incidence rates of 35.1% for ERM and 15.2% for CME. The incidence of ERM after combined PPV and scleral buckling (48.4%) (n = 61) was greater (p&lt;0.0001) compared to that after PPV alone (31.2%) (n = 144).

CONCLUSIONS

Epiretinal membrane and CME develop frequently after small-gauge RD repair. Pars plana vitrectomy combined with scleral buckling is associated with a higher incidence of ERM. Patients might benefit from increased use of OCT and FA to help rule out CME/ERM.

Clinical and spectral-domain optical coherence tomography findings of patients with incomplete visual recovery after anatomically successful retinal detachment surgery

Purpose. To identify causes of incomplete visual recovery in patients with anatomically successful retinal detachment surgery. Methods. This was a retrospective study of 61 eyes of 61 patients with at least 12-month follow-up and complete preoperative, intraoperative, and postoperative record. Postoperative visual acuity (VA) more than 0.18 logMAR was considered as incomplete visual recovery. Complete ophthalmic examination and Spectral-Domain OCT (SD-OCT) imaging were performed at last follow-up. Results. Twenty-nine eyes (47.5%) had a postoperative VA < 0.18 logMAR and 32 eyes (52.5%) had a postoperative VA ≥ 0.18 logMAR. Mean follow-up was 32.8 ± 17.3 months. Incomplete visual recovery was strongly correlated with presence of macular pathology (P = 0.002), a detached macula preoperatively (P = 0.02), retinotomy (P = 0.025), and pars plana vitrectomy and use of silicon oil as a tamponade agent (P = 0.009). Also, although there was a strong correlation between ellipsoid zone disruption and incomplete visual recovery, a distinct, more course pathology could be identified in all cases of poor visual recovery related to edema, thickening, or atrophy of the macula. Conclusion. The careful postoperative evaluation of the macula using biomicroscopy and SD-OCT can help in diagnosis of alterations that can be associated with incomplete visual recovery.

Influence of intravitreal triamcinolone acetonide injection in scleral buckling surgery for macula-off retinal detachment

PURPOSE

To investigate the effect of intravitreal triamcinolone acetonide injection on the resolution of subretinal fluid (SRF), and its correlation with visual outcome after scleral buckle (SB) surgery.

METHODS

A prospective consecutive case series was conducted in patients who underwent SB surgery for macula-off rhegmatogenous retinal detachment (RRD) at Farabi Eye Hospital from February 1, 2012 to August 30, 2013. Exclusion criteria included previous ocular surgery (e.g. primary surgical failure) except cataract surgery, recurrent retinal detachment, macular hole, epiretinal membrane, proliferative vitreoretinopathy grade C, history of trauma, other retinal diseases, and diabetes mellitus. Patients were assigned to two groups. In group 1, patients received 2 mg of intravitreal triamcinolone acetonide injection at the end of surgery while patients in group 2 received intravitreal balanced saline solution for balancing the intraocular pressure (IOP). Patients were followed up at 1 day, 1 week, 1 month, 2 months and 3 months after the surgery by best-corrected visual acuity (BCVA), slitlamp examination, indirect ophthalmoscopy and optical coherence tomography (OCT). OCT (Heidelberg Engineering, Heidelberg, Germany) was used at all visits except day 1 after the surgery. Student's t test and χ(2) tests were used for comparisons; p value ≤ 0.05 was considered significant.

RESULTS

Sixty-two eyes of 62 patients were enrolled in the study. There were 33 male patients (53%) and 29 female patients (47%). The average age was 43.8 years (18-72 years). The mean duration of symptoms was 34.7 ± 46.8 days. There were 29 eyes in group 1 and 33 eyes in group 2. Twelve weeks after the operation, 25 patients (40%) had SRF beneath the macula, but there was no significant difference (p = 0.24, χ(2) test) between the two groups. Improvement in BCVA in both groups was statistically significant (p ≤ 0.001) but did not differ between the two groups (p = 0.09) apart from week 12, in which the improvement in group 1 was significantly higher (p = 0.03). The incidence of cystoid macular edema did not differ in a statistically significant way between the groups (p = 0.19). IOP in 4 (15%) patients in group 1 rose above 21 mm Hg but responded quickly to 2 weeks of topical antiglaucoma medication. There was no cataract progression in either group. There was no correlation between the incidence of persistent SRF and the extent of detachment in both groups (p = 0.83). There was no surgical failure or redetachment in either group during the study period.

CONCLUSION

Single-dose intravitreal triamcinolone may increase the final BCVA in macula-off RRD patients despite persistent SRF, suggesting the anti-inflammatory role of this drug.

[Scleral buckling for inferior rhegmatogenous retinal detachments]

PURPOSE

To investigate the epidemiological, clinical, therapeutic and prognostic factors in cases of inferior rhegmatogenous retinal detachments (RD) treated by scleral buckling surgery.

PATIENTS AND METHODS

A retrospective chart review was performed on 45 patients (45 eyes) with inferior RD with only inferior tears (4:00-8:00), who had been treated by scleral buckling surgery over a 6-year period from 2006 to 2011. The parameters studied included patient demographics, refractive status, time until consultation, clinical exam data, treatment modalities and functional and anatomic results.

RESULTS

Forty-five cases were included in this study (45 eyes), with an average patient age of 44.5 years (14 to 75 years) and a slight male predominance (56%). Myopia was observed in 60%. Mean time until consultation was 3.5 months. Visual acuity on admission was less than 1/10 in 53.33%. Macular detachment was found in 80%. Causative lesions were holes in 26 eyes. Proliferative vitreoretinopathy was essentially stage B in 48.9%. Scleral buckling surgery was performed in all patients, with drainage of subretinal fluid in 37.8%. Retinal reattachment was obtained in 36 eyes (80%) with a final visual acuity greater than or equal to 1/10 in 71.11%. The mean follow-up in our study was 6.62 months.

CONCLUSION

Inferior retinal detachment has a predilection for young myopes. The time until consultation is often long, and extraocular surgery, although difficult, exhibits documented efficacy.

Changes in contrast sensitivity after surgery for macula-on rhegmatogenous retinal detachment

PURPOSE

To evaluate changes in contrast sensitivity after surgery for macula-on rhegmatogenous retinal detachment (RRD).

DESIGN

Prospective, interventional, consecutive, case-control study.

METHODS

This study included 84 eyes of 84 patients with unilateral macula-on RRD undergoing primary scleral buckling or vitrectomy without postoperative macular complication. We examined the logarithm of the minimal angle of resolution best-corrected visual acuity (logMAR BCVA) and contrast sensitivity at 4 spatial frequencies (3, 6, 12, and 18 cycles/degree) using the CSV-1000E (Vector Vision) before and after surgery. From the data obtained with the CSV-1000E, the area under the log contrast sensitivity function was calculated. The logMAR BCVA and contrast sensitivity in the contralateral normal eyes also were measured and were used as normal controls. Clinical data were collected, including age, gender, surgical procedures, the number of retinal tears, circumferential dimension of retinal tears, and area of retinal detachment, to determine the clinical factors related to visual function.

RESULTS

Preoperative contrast sensitivity was significantly worse in eyes with RRD than in normal controls, but the preoperative logMAR BCVA was not different from that of normal controls. Contrast sensitivity decreased significantly after surgery, but logMAR BCVA did not change by surgery. Multiple regression analysis revealed that postoperative contrast sensitivity had a significant correlation with the circumferential dimension of retinal tears, whereas no clinical parameters were associated significantly with postoperative BCVA.

CONCLUSIONS

Surgery for macula-on RRD did not change visual acuity, whereas contrast sensitivity was affected significantly in association with the extent of retinal tears.

[Results of scleral buckling for rhegmatogenous retinal detachment in phakic eyes]

PURPOSE

To report the results of primary scleral buckling in the treatment of uncomplicated rhegmatogenous retinal detachment in phakic eyes and to determine risk factors for failure.

PATIENTS AND METHODS

Retrospective study of 100 consecutive phakic eyes undergoing surgery for uncomplicated retinal detachment. All patients underwent cryopexy, scleral buckling with hard silicone explant type 287 and in selected cases, drainage of subretinal fluid and gas tamponnade with air or SF6.

RESULTS

The primary anatomic success rate was 84% and 99% respectively after one or multiple procedures. The causes of failure were new breaks (50%), proliferative vitreoretinopathy (31.2%) and malposition of the scleral buckle (18.8%). Mean visual acuity improved from 0.77±0.75 logMar to 0.21±0.19 logMar (P<0.00001). Predictive risk factors for failure included extent of the detachment beyond one quadrant and multiple breaks (P=0.03). Horseshoe tears had a worse prognosis than oral dialysis or atrophic round holes (P=0.04).

CONCLUSION

Scleral buckling remains safe and effective for the treatment of uncomplicated rhegmatogenous retinal detachments in phakic eyes, especially when the extent of the detachment was less than one quadrant or in the presence of a single tear, an atrophic round hole or an oral dialysis.

Correlation between spectral-domain optical coherence tomography findings and visual outcome after primary rhegmatogenous retinal detachment repair

PURPOSE

To correlate the postoperative visual outcome with the spectral-domain optical coherence tomography (SD-OCT) findings in the fovea after successful rhegmatogenous retinal detachment repair. Cross-sectional, observational study.

METHODS

Thirty-five patients with preoperative macula-on rhegmatogenous retinal detachment (12 eyes) and macula-off rhegmatogenous retinal detachment (23 eyes) who underwent scleral buckling surgery for primary rhegmatogenous retinal detachment were recruited. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity measurement, microperimetry, and SD-OCT examination were performed on the same day. Foveal center retinal thickness, central 1-mm subfield thickness, and outer nuclear layer thickness were measured using SD-OCT. The presence or absence of epiretinal membrane, intraretinal fluid, and subretinal fluid was assessed. The status of the external limiting membrane, inner/outer segment junction, and intermediate line was also evaluated and judged as disrupted or complete. The correlations between SD-OCT findings and either postoperative best-corrected visual acuity or retinal sensitivities for central 12° were analyzed.

RESULTS

The outer nuclear layer thickness was the only significant SD-OCT retinal measurement strongly correlated with both postoperative best-corrected visual acuity (r = 0.61; P < 0.001) and retinal sensitivities for central 12° (r = 0.53; P = 0.001). Among the SD-OCT imaging findings, status of the external limiting membrane, inner/outer segment junction, and intermediate line and the presence of intraretinal fluid showed a significantly high correlation either with best-corrected visual acuity outcome (r = -0.60; P < 0.001, r = -0.63; P < 0.001, r = -0.66; P < 0.001, and r = -0.50; P = 0.002, respectively) or with postoperative retinal sensitivities (r = -0.59; P < 0.001, r = -0.61; P < 0.001, r = -0.66; P < 0.001, r = -0.50; P = 0.002, respectively). Multivariate analysis showed that the outer nuclear layer thickness and the status of the intermediate line were the most important predictors of visual outcome (P < 0.001 and P < 0.001, respectively).

CONCLUSION

This study showed that not only the status of the external limiting membrane and the inner/outer segment junction but also the integrity of the intermediate line and the outer nuclear layer thickness changes may be important predictors of postoperative visual outcome after anatomically successful rhegmatogenous retinal detachment repair.

Persistent subfoveal fluid and increased preoperative foveal thickness impair visual outcome after macula-off retinal detachment repair

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.

Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment: hypothesis and review

BACKGROUND

Persistent subretinal fluid after rhegmatogenous retinal detachment (RRD) surgery is responsible for delayed recovery, and may affect the final visual outcome. Cause, consequences, and treatment remain elusive.

DESIGN

Literature review and case series.

METHODS

We reviewed the pathophysiological principles and therapeutic options from the literature, and we report the results from a subretinal fluid cytology study. Nine eyes from nine patients with macula-involving RRD underwent surgical repair. The cellular content of subretinal fluid (SRF) was studied by electron microscopy and anti-rhodopsin immunostaining. All eyes were assessed postoperatively with optical coherence tomography for the detection of persistent submacular fluid (PSF) (Ethics Committee Ghent University Hospital, registration number B6702006169).

RESULTS

Certain patient characteristics as well as surgical methods were implicated. PSF appears to occur more frequently in patients with longstanding detachments treated with buckling surgery. Several therapeutic options have been suggested but safety and efficacy remain unclear. We found PSF in three eyes on postoperative OCT scans, which corresponded to the three cell-rich subretinal samples.

CONCLUSIONS

PSF after successful RRD repair seems to be related to fluid composition. We hypothesize, in the absence of an effective treatment, that a modified surgical drainage, including a washout of the subretinal space, could evacuate the subretinal fluid more completely, and may prevent this complication.

The photoreceptor layer as a prognostic factor for visual acuity in the secondary epiretinal membrane after retinal detachment surgery: imaging analysis by spectral-domain optical coherence tomography

PURPOSE

To study the prognostic factors that influence best-corrected visual acuity (BCVA) outcome in patients with secondary epiretinal membrane (ERM) after retinal detachment surgery.

DESIGN

Retrospective case series.

METHODS

Forty-two patients with ERM were divided into macula-on and macula-off groups based on the macular status before retinal detachment surgery and were studied using the same spectral-domain optical coherence tomography device. Several variables, including the integrity of the external limiting membrane (ELM), the status of the photoreceptor inner segment/outer segment (IS/OS) junction line, and central foveal thickness were evaluated in 17 treated and 25 untreated patients. Linear regression analysis was used to determine the best combination of all variables affecting BCVA.

RESULTS

Final BCVA was significantly better in macula-on and macula-off eyes with intact ELMs and IS/OS junction lines (0.35 ± 0.18 logarithm of the minimal angle of resolution [logMAR] and 0.51 ± 0.17 logMAR, respectively) than in macula-off eyes with disrupted or absent ELMs and IS/OS junction lines (0.83 ± 0.17 logMAR and 1.04 ± 0.05 logMAR, respectively; P < .001, analysis of variance). Final BCVA also was better in the treated group than in the controls (0.55 ± 0.31 logMAR and 0.73 ± 0.26 logMAR, respectively; P = .05, t test). ELM and IS/OS junction line integrity were the main variables significantly affecting the final BCVA outcome (β = 0.42; P = .006, linear regression analysis). Disruption of the ELM and IS/OS junction line was observed in 21 of the 42 cases studied.

CONCLUSIONS

ERM secondary to retinal detachment surgery is accompanied by a high incidence (50%) of IS/OS junction line and ELM disruption. Among the variables studied, the condition of the IS/OS junction layer and the ELM are the main factors that predict final BCVA after ERM peeling.

The significance of the external limiting membrane in the recovery of photoreceptor layer after successful macular hole closure: a study by spectral domain optical coherence tomography

PURPOSE

To evaluate the external limiting membrane (ELM) by spectral domain optical coherence tomography (SDOCT) and its correlation with the inner segment/outer segment (IS/OS) line in patients with successful macular hole surgery.

PROCEDURES

Forty-five eyes were divided into 3 groups according to the interval between surgery and first examination. In the first group the interval was between 6 and 12 months, in group 2 it was >12 months and ≤ 24 months, and in group 3 it was >24 months. The IS/OS and ELM of participants' eyes were postoperatively assessed using SDOCT in 2008 and 12 months later.

RESULTS

A statistically significant association between the integrity of the ELM and the IS/OS junction line was observed in postoperative examinations in all 3 groups. Eyes with a complete IS/OS junction line had an intact ELM. Between the first and the second examinations, a significant improvement in best-corrected visual acuity (BCVA) was noted only in group 1. A positive statistical association was also observed in group 1 between restoration of the IS/OS junction line and improvement in BCVA over follow-up.

CONCLUSIONS

The restoration of the IS/OS junction line is directly related to the integrity of the ELM.

Long-term follow-up with optical coherence tomography and microperimetry in eyes with metamorphopsia after macula-off retinal detachment repair

PURPOSE

to report the long-term sequential morphological and functional results in eyes with metamorphopsia after retinal detachment (RD) repair.

PATIENTS AND METHODS

in six eyes of six patients aged 58.7 ± 11.0 years with metamorphopsia after successful buckling surgery for macula-off RD, best-corrected visual acuity (BCVA), fundus biomicroscopy, Amsler grid test, time-domain optical coherence tomography (TD-OCT) and central 12° microperimetry (MP-1) were performed at months 1, 3, 6, 12, and 18. At 5 to 6 years after surgery all patients underwent also spectral domain (SD)-OCT.

RESULTS

three eyes slowly recovered pre-RD BCVA. In the remaining three eyes-with good final BCVA-the interrupted junction line between photoreceptor cell inner and outer segments (IS/OS) was progressively less evident after RD surgery; and the external limiting membrane was preserved on SD-OCT examination. In all eyes post-operative metamorphopsia faded with time, but fully disappeared in 6 years only in two eyes without photoreceptor abnormalities. One of the two eyes with subretinal fluid up to 6 months and IS/OS disruption had central dense scotoma with relatively unstable fixation on MP-1 and persistent metamorphopsia. Macular sensitivity (MS) increased from 9.7 ± 7.1 at month 1 to 13.5 ± 5.6 dB at the final check, and was weakly (r=0.33) correlated with post-operative BCVA and OCT abnormalities.

CONCLUSION

long-standing metamorphopsia can occur after successful macula-off RD repair even without detectable photoreceptor disruption on OCT. Post-operative BCVA recovery weakly correlates with increasing MS, and late restoration of the photoreceptor layer may be observed.

Scleral buckle removal as treatment for persistent subfoveal fluid after scleral buckle surgery for retinal detachment

PURPOSE

To describe the removal of scleral buckle (SB) as a potential treatment option for persistent subfoveal fluid after SB retinal reattachment surgery.

METHODS

Case report of a single patient.

RESULTS

A 56-year-old man with a preoperative best-corrected visual acuity of 20/20 underwent SB surgery for a macula-on retinal detachment. Postoperatively he developed subfoveal fluid with best-corrected visual acuity ranging from 20/30 to 20/40. Nine months after the original retinal reattachment surgery, the patient underwent SB removal as a treatment for persistent subfoveal fluid and incomplete recovery of visual acuity. One week after SB removal, the subfoveal fluid was substantially diminished and best-corrected visual acuity had returned to 20/20.

CONCLUSION

This case suggests that removal of SB after retinal reattachment may be a viable treatment option in patients with persistent subfoveal fluid on optical coherence tomography and incomplete recovery of preoperative visual acuity.

Subretinal fluid bleb after successful scleral buckling and cryotherapy for retinal detachment

PURPOSE

To determine the characteristics of subretinal fluid (SRF) blebs after successful scleral buckling with cryotherapy as a treatment for rhegmatogenous retinal detachment (RD) and to investigate their possible origin.

DESIGN

Retrospective case series.

METHODS

The incidence of SRF bleb and the temporary aspects associated with the appearance and disappearance of the lesion were analyzed. Optical coherence tomography (OCT) was used to confirm SRF and indocyanine green angiography (ICGA) was carried out to evaluate choroidal circulation in some of the cases.

RESULTS

SRF bleb was observed in 11 (9.3%) of 118 cases with the history of successful scleral buckling and cryotherapy. The lesions were detected 8.7 +/- 5.5 (mean +/- standard deviation [SD]) weeks after complete retinal reattachment, and the mean +/- SD period required for the disappearance of the lesion was 4.7 +/- 3.4 months. SRFs were verified by OCT in five cases of macular involvement. ICGA revealed choroidal vascular congestion and hyperpermeability near the lesion in three of four cases, and these vascular abnormalities remained unchanged after the removal of the scleral explant.

CONCLUSIONS

SRF bleb after successful RD surgery disappears spontaneously within one year. The origin of the lesion may be associated with choroidal vascular changes resulting from cryotherapy.

Anatomical retinal reattachment after scleral buckling with and without retinopexy: a pilot study

PURPOSE

To compare the anatomical results of scleral buckling with and without retinopexy and to assess the effect of retinopexy on the scleral buckling outcome.

METHODS

This randomized clinical trial was performed on 55 patients. Twenty-two eyes were treated with scleral buckling (segmental or encircling) with or without drainage of subretinal fluid without any type of retinopexy (group 1); 33 patients received transscleral retinal cryopexy around retinal break(s) in addition to the former procedure. The two groups were matched regarding age, sex, myopia, aphakia, stage of proliferative vitroretinopathy (PVR) and number, type and location of the break(s).

RESULTS

In the non-retinopexy group, 19 patients (86%) had complete retinal reattachment and one patient had partial reattachment after 34-48 months of follow-up. One patient did not develop attachment because of missed break out of the buckle, and one had no attachment at all because of PVR. Overall success rate was 91% (20 of 22) in this group. In the retinal cryopexy group, 26 patients (79%) had complete retinal reattachment and two had partial reattachment during 35-56 months of follow-up. In two patients, no attachment was achieved because of missed break out of the buckle; three patients developed redetachment after 1 and 3 months because of PVR. Overall success rate was 85% (28 of 33). The anatomical results in these two groups were the same statistically.

CONCLUSION

With the permanent scleral buckling technique, retinal cryopexy adds no benefit to the success rate of anatomical retinal reattachment.

Persistance de liquide sous-rétinien maculaire après traitement d’un décollement de rétine rhegmatogène par cryothérapie-indentation

We report the case of a phakic patient with late visual recovery after successful surgery of macula-off retinal detachment, using the scleral buckling procedure. Visual acuity remained low because of the persistence of subfoveal fluid despite the reattachment of peripheral retina. The amount of subfoveal fluid decreased slowly and final visual acuity finally recovered. We used optical coherence tomography (OCT) to quantify the remaining subfoveal fluid. Persistence of submacular fluid can explain late visual recovery after surgical treatment of retinal detachment.

Retinal function after scleral buckling for recent onset rhegmatogenous retinal detachment: assessment with electroretinography and optical coherence tomography

PURPOSE

To investigate central and peripheral retinal function after scleral buckling surgery for recent onset rhegmatogenous retinal detachment (RD).

METHODS

Fifteen phakic patients with rhegmatogenous RD for <1 week underwent scleral buckling surgery. Clinical investigation, optical coherence tomography (OCT), full-field electroretinography (ERG), and multifocal ERG (mfERG) with fundus illumination were performed preoperatively and 6 months postoperatively.

RESULTS

Anatomical success was achieved in 14 patients. mfERG amplitudes were reduced preoperatively in detached retina, with significant improvement at follow-up (P = 0.002). Foveal amplitudes improved significantly (P = 0.027). There was no significant difference in postoperative mfERG amplitudes between areas that had been preoperatively detached or attached (P = 0.739). In the subgroup of eight patients in whom the detachment engaged the fovea preoperatively, rod function improved significantly as assessed with full-field ERG (P = 0.008). In these patients, the extent of detachment ranged between 4 clock hours and 6 clock hours, as compared with 2 clock hours and 5 clock hours in the remaining patients. OCT showed subretinal foveal fluid in four patients at follow-up.

CONCLUSIONS

In recent onset rhegmatogenous RD, total rod and localized central retinal dysfunction in detached retina can improve significantly after reattachment. mfERG and OCT are suitable tools for further studies of functional outcomes in RD.

Optical Coherence Tomography Analysis of the Macula after Scleral Buckle Surgery for Retinal Detachment

OBJECTIVE

To define the incidence, pattern, duration, and clinical consequences of persistent localized submacular fluid after scleral buckle surgery for retinal detachment (RD).

DESIGN

Prospective observational cohort series.

PARTICIPANTS

Ninety-eight patients were identified and recruited to the study.

METHODS

Patients aged > or =18 years undergoing scleral buckle surgery for uncomplicated primary RD over an 18-month period were recruited. All patients underwent clinical examination and optical coherence tomography (OCT) scan of the macula preoperatively and at 6 weeks postoperatively. Those patients who had an abnormality on OCT 6 weeks after surgery underwent follow-up with repeat of the study investigations at 3, 6, 9, 12, and 18 months after surgery until the abnormality resolved. If no abnormality was seen at the 6-week examination, no further investigation was undertaken.

MAIN OUTCOME MEASURE

Presence of submacular fluid on OCT 6 weeks after surgery. Other outcome measures were duration of persistent fluid and associations with poor visual outcome, type, or duration of detachment.

RESULTS

Of the 98 patients recruited into the study, 54 (55%) had subretinal fluid (SRF) on OCT 6 weeks after surgery. We identified 3 patterns of submacular fluid: confluent fluid, a single discrete bleb of fluid, and multiple blebs of fluid. Fluid was associated with delayed visual recovery. Of those with SRF, 78% had persistent fluid at 6 months; resolution of fluid took a median of 10 months and was associated with an improvement in vision.

CONCLUSIONS

Optical coherence tomography is a useful noninvasive diagnostic method that can detect SRF not seen on clinical examination. Persistent SRF 6 weeks after scleral buckle surgery occurs in approximately half of patients, may persist for many months, and can cause delayed visual recovery.

Optical Coherence Tomography Analysis of the Macula after Vitrectomy Surgery for Retinal Detachment

OBJECTIVE

To define the incidence, duration, and clinical associations of persistent localized submacular fluid after pars plana vitrectomy (PPV) retinal detachment surgery.

DESIGN

Observational cohort series.

PARTICIPANTS

One hundred patients were identified and recruited into the study.

METHODS

Patients aged 18 years and older who had undergone PPV and gas as a primary procedure for rhegmatogenous retinal detachment and postoperative follow-up were recruited from February through August 2004. All patients underwent clinical examination, optical coherence tomography (OCT) scan of the macula, and retinal thickness analysis scan of the macula. Those patients in whom an abnormality was seen on OCT at 6 weeks after surgery underwent follow-up with repeat of the study investigations at 3, 6, 9, 12, and 18 months after surgery until the abnormality resolved. If no abnormality was seen at the 6-week examination, no further investigation was undertaken. Demographic data, including detachment characteristics, were collected retrospectively from the patient case notes.

MAIN OUTCOME MEASURES

The principle outcome measure was the presence of subretinal fluid (SRF) on OCT at 6 weeks after surgery. Other outcome measures included duration of persistent fluid and association with visual outcome and type and duration of detachment.

RESULTS

One hundred patients were recruited; 15 of these had SRF on OCT performed at 6 weeks after surgery. Subretinal fluid was associated with significantly worse visual acuity (VA) at 6 weeks (P = 0.033, Wilcoxon rank-sum); those with SRF had a median VA of 0.4, and those with no SRF had a median VA of 0.3. The fluid took a median of 5.5 months to resolve. Seven patients had combined PPV and scleral buckle surgery; none of these had fluid at 6 weeks.

CONCLUSIONS

Optical coherence tomography is a useful noninvasive diagnostic method that can detect SRF not appreciated on clinical examination. Persistent SRF after PPV and gas surgery occurred in 15% of patients in this study and was still present in 53% of these at 6 months. The presence of SRF at 6 weeks after surgery was associated with a poorer visual outcome at this time point.

Ocular coherence tomographic examination of postoperative foveal architecture after scleral buckling vs vitrectomy for macular off retinal detachment

AIMS

This pilot study uses Optical Coherence Tomography (OCT) imaging to compare the difference in foveal architecture after successful retinal detachment (RD) surgery by scleral buckling or pars plana vitrectomy (PPV).

METHODS

Prospective recruitment of patients with macular off RDs. Detachment surgery was undertaken by scleral buckling, external drainage, and air injection (group 1) or by PPV (group 2). Postoperatively patients had clinical examinations and OCT at 1, 3, 6, and 12 months. If abnormalities persisted, a further OCT was obtained at 18 months.

RESULTS

Retinal reattachment, including clinical macular reattachment, was achieved in all cases within 24 h postoperatively. In group 1 (n=22), postoperative OCT showed persistent foveal detachment in 63% of cases (n=14) at 1 and 3 months. At 6 and 12 months, 36% (n=8) and 9% (n=2) had a persistent foveal detachment, respectively, and at 18 months, foveal detachment eventually. In group 2 (n=21), postoperative OCT showed an attached fovea in all cases; however, foveal thickening suggesting intraretinal oedema was present in all cases. The oedematous appearance of retina on OCT settled in 1-3 months. No foveal abnormality was seen at 6 and 12 months postoperatively.

CONCLUSIONS

A high proportion of patients with successful retinal reattachment surgery by scleral buckling had foveal detachments postoperatively. No cases who had PPV had foveal detachments; however, transient retinal oedema was evident in all cases. The aetiology of these changes is unknown and warrants further investigation, as there is the potential of a long-term effect on vision.

Ultrahigh-resolution optical coherence tomography in patients with decreased visual acuity after retinal detachment repair

OBJECTIVE

To assess microstructural changes in the retina that may explain incomplete visual recovery after anatomically successful repair of rhegmatogenous retinal detachments (RD) using ultrahigh-resolution optical coherence tomography (UHR OCT).

DESIGN

Retrospective observational case series.

PARTICIPANTS

Seventeen patients with decreased visual acuity after RD repair. Twelve patients had macula-involving and 5 had macula-sparing RDs.

METHODS

The UHR OCT prototype capable of approximately 3 mum axial resolution was developed for clinical use. The UHR OCT images through the center of the fovea in 17 patients with visual complaints after RD surgery were obtained. Patients were either postoperative patients from the New England Eye Center or tertiary referrals. Baseline visual acuity, preoperative lens status, location of retinal detachment, macular involvement, and postoperative visual acuity were recorded.

MAIN OUTCOME MEASURES

The UHR OCT images after RD repair.

RESULTS

The UHR OCT images were obtained 1 to 84 months (median, 5 months) postoperatively. The mean preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity was 1.37 (Snellen equivalent, 20/390). The mean postoperative logMAR visual acuity was 0.48 (Snellen equivalent, 20/60). Anatomical abnormalities that were detected included distortion of the photoreceptor inner/outer segments (IS/OS) junction in 14 of 17 patients (82%), epiretinal membranes in 10 of 17 patients (59%), residual subretinal fluid in 3 of 17 patients (18%), and cystoid macular edema in 2 of 17 patients (12%). Of the 5 patients with preoperative macula-on detachments, 4 had distortion of the outer retina after RD repair.

CONCLUSIONS

The higher resolution of UHR OCT facilitates imaging of the IS/OS junction. Therefore, UHR OCT is able to confirm prior histopathologic findings that damage to photoreceptor outer segments may occur as a consequence of retinal detachment. This may explain poor postoperative visual acuity in eyes with anatomically successful repair.

Foveal detachment after successful retinal reattachment for macula on rhegmatogeneous retinal detachment: an ocular coherence tomography evaluation

PURPOSE

Foveal detachment after apparently successful retinal reattachment surgery for macula-on retinal detachments (RDs) has been previously documented. This pilot study aimed to utilize ocular coherence tomography (OCT) imaging to investigate foveal architecture after routine retinal detachment surgery and correlate this to visual acuity.

METHODS

Prospective recruitment of patients attending one unit with macula-on RDs. Patients underwent full clinical examination including OCT preoperatively and RD surgery undertaken by scleral buckling, external drainage and air injection. Postoperatively patients had clinical examinations and OCT at 1 week, 1, 3, 6, and 12 months.

RESULTS

A total of 12 consecutive patients were recruited into the study. All had macula-on RDs and normal OCTs at onset. There were no operative or postoperative complications. Retinal reattachment was achieved in all cases within 24 h postoperatively. At 1 month six of 12 patients (50%) showed foveal detachment on OCT, which was invisible on clinical examination. At 3 months, the foveal detachment persisted in four (33%) of these patients. In these cases the foveal detachment persisted at 6 months follow-up, however, a reduction in subfoveal fluid was noted. All cases had foveal reattachment by 12 months postoperatively. Visual acuity was closely correlated to the presence of foveal attachment.

DISCUSSION

A high proportion of patients with successful retinal reattachment surgery had foveal detachments postoperatively. This phenomenon was associated with reduced visual acuity. The aetiology of this occurrence is unknown and warrants further investigation as there is the potential of a long-term effect on vision.

Assessment of the reproducibility and repeatability of a method of grading macular subretinal fluid using optical coherence tomography

AIM

To devise a quantative method for the measurement of the extent of macular subretinal fluid using optical coherence tomography (OCT), and to assess the interobserver and intraobserver agreement for this grading system.

METHODS

Observational cohort series. Patients were a cohort who underwent retinal detachment surgery over an 18-month period. All patients had OCT scan at 6 weeks after surgery. The scans were graded by two independent observers experienced in OCT interpretation and each grader was masked to the others findings. Observer 1 then regraded the scans on a later day masked to his previous findings. The interobserver and intraobserver agreement was assessed using weighted Kappa (Kw) statistics.

RESULTS

In all, 116 patients were analysed. Both the intraobserver and interobserver agreement was very high, with Kw being 0.9631 and 0.9070, respectively.

CONCLUSIONS

The grading system for assessment of the extent of macular subretinal fluid using OCT appears to have very good reproducibility and repeatability. We propose that this grading system would be clinically useful when applied to pathologies visible on OCT scan of the macula.

Metamorphopsia after successful retinal detachment surgery: an optical coherence tomography study

PURPOSE

To investigate the findings in optical coherence tomography (OCT) in eyes with metamorphopsia after scleral buckling surgery for macula-off retinal detachment.

METHODS

A total of 46 patients (46 eyes) with macula-off retinal detachment were prospectively studied 2 months after successful scleral buckling surgery. Patients were examined with the Amsler grid, fundus biomicroscopy and OCT.

RESULTS

At the 2 month follow-up, 31/46 (67%) patients had metamorphopsia; 24/31 (77%) of these patients had an abnormal macular structure on OCT and 7/31 (23%) showed a normal macula. However, of the 15 patients in the non-metamorphopsia group, 4/15 (27%) had an abnormal macula and 11/15 (73%) had a normal macula (p = 0.0015). The most common finding on OCT was neurosensory retinal detachment.

CONCLUSIONS

Metamorphopsia after scleral buckling surgery in macula-off detachment is more common in patients in whom abnormal macular structure is seen on the OCT scan compared to those showing a normal macular structure. Neurosensory retinal detachment is the most common pathology in these patients.

Optical coherence tomography to detect and manage retinal disease and glaucoma

PURPOSE

To review basic principles of optical coherence tomography, and to describe its use in the diagnosis and management of retinal diseases and glaucoma.

DESIGN

Perspective.

METHODS

Literature review.

RESULTS

Optical coherence tomography is a noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases and glaucoma. Optical coherence tomography (OCT) is based on the principal of Michelson interferometry. Interference patterns produced by low coherence light reflected from retinal tissues and a reference mirror are processed into an "A-scan" signal. Multiple A-scan signals are aligned to produce a two-dimensional image that can be thought of as a form of "in vivo histology." Optical coherence tomography has been used to identify macular holes, to differentiate macular holes from simulating lesions, to identify lamellar macular holes, macular cysts, vitreomacular traction, subretinal fluid, pigment epithelial detachment, and choroidal neovascularization. It can be used to identify and quantify macular edema, and to measure retinal thickness changes in response to therapy. Macular thickness measurements determined by OCT correlate well with visual acuity and with leakage observed by fluorescein angiography. Optical coherence tomography is an accurate and reproducible method to measure retinal nerve fiber layer thickness. Particularly, when used in combination with other optic nerve imaging techniques, it can be used to differentiate glaucomatous eyes from normal eyes. Despite its usefulness, OCT has its limitations. Optical coherence tomography equipment is expensive, and not all insurance companies reimburse this procedure. Image quality is dependent on operator technique and can be degraded in the presence of media opacity. Change analysis software for glaucoma applications is not fully developed, and there is a scarcity of age, gender, and race-specific normative data upon which to compare eyes with retinal disease and glaucoma. In the next few years, it is likely that the role of OCT as a method to diagnose and manage retinal disease and glaucoma will be further defined, and many of the current limitations will be overcome.

CONCLUSIONS

Optical coherence tomography is a useful imaging technique to diagnose and manage a variety of retinal diseases and glaucoma. Care is needed to avoid artifacts and image misinterpretation.