New optical coherence tomography grading system for macula-off rhegmatogenous retinal detachment: how off is off?

Quantitative Microvascular Change Analysis Using a Semi-Automated Software in Macula-off Rhegmatogenous Retinal Detachment Assessed by Swept-Source Optical Coherence Tomography Angiography

Objective: To analyze the performance of custom semi-automated software for quantitative analysis of retinal capillaries in eyes with macula-off rhegmatogenous retinal detachment (RRD) and the role of these microvascular measures as potential biomarkers of postoperative visual outcomes. Methods: A prospective, observational, and single-center study was conducted on consecutive patients who underwent 25G pars-plana vitrectomy for primary uncomplicated macula-off RRD. Optical coherence tomography angiography (OCTA) was performed in the fellow and RRD eyes before surgery and in months 1, 3, and 6 after surgery. The preoperative values of the fellow eyes were used as surrogates of macula-off ones. The primary endpoints were the mean vessel diameter index (VDI); vessel area density (VAD); and vessel skeleton density (VSD) at month 6. Results: Forty-four eyes (44 patients) were included in the study. Considering the fellow eyes as a surrogate of preoperative values of macula-off eyes, VDI in superficial (SCP) and deep (DCP) capillary plexuses was significantly reduced at month 6 (p = 0.0087 and p = 0.0402, respectively); whereas VSD in SCP increased significantly from preoperative values (p = 0.0278). OCTA built-in software parameters were significantly reduced from month 1 to month 6 in both SCP and DCP (p values ranged between 0.0235 and <0.0001). At month 6, 25 (56.8%) eyes achieved a best-corrected visual acuity BCVA ≥ 0.3 (LogMAR). The greater the preoperative BCVA, the greater the probability of achieving good visual outcomes (Odds ratio: 11.06; p = 0.0037). However, none of the OCTA parameters were associated with the probability of achieving a BCVA improvement ≥ 0.3. Conclusions: Quantitative evaluation of capillary density and morphology through OCTA and semi-automated software represents a valuable tool for clinical assessment and managing the disease comprehensively.

How should we report the foveal status in eyes with "macula-off" retinal detachment?

Whilst pre- and postoperative multimodal imaging technologies including optical coherence tomography (OCT) have investigated the morphological correlates of worsened visual outcomes in rhegmatogenous retinal detachment (RRD) with foveal involvement, the nomenclature has adhered to the traditional ophthalmoscopy-based and rather vague term "macula-off". This article appraises the current literature with regard to the preoperative assessment and nomenclature of the foveal status in macula involving retinal detachment (MIRD). A literature review of recent publications assessing functional or morphological outcomes in MIRD was conducted, using the search terms "fovea-off" or "macula-off". The search date was April 28^th, 2021. Original studies in English language were included. Case reports, review articles or letters were excluded. Forty relevant articles (range of publication dates: July 29^th, 2020 - April 18^th, 2021) were reviewed to assess the diagnostic modalities used, morphological parameters assessed, and any specific nomenclature introduced to specify the extent of macular detachment. The results suggest widespread variability and inconsistencies with regard to the preoperative assessment, diagnostic modalities and nomenclature used to describe the foveal status in eyes with RRD termed "macula-off". The extent of macular detachment may be classified by a wide range of morphological parameters, including the height of foveal detachment and the ETDRS grid as overlay tool in OCT devices. There is a scientific and clinical need for an updated nomenclature for eyes with "macula-off" RRD. Preoperative OCT findings should be reported on a regular and standardized basis in order to establish a consensus how to report the foveal status in eyes with MIRD.

Importance of subfoveal fluid height on visual outcome in macula-off retinal detachments

AIMS

To investigate the effect of subfoveal fluid height (SFFH) on visual outcome after macula-off retinal detachment (RD) repair.

METHODS

Prospective interventional case series of consecutive patients undergoing pars plana vitrectomy with gas tamponade (PPV) for primary macula-off RD with duration of symptomatic loss of central vision (LCV) of ≤1 week. Preoperative SFFH was measured on two occasions an hour apart using optical coherence tomography (OCT) by two independent observers. Postoperative best corrected visual acuity (BCVA) was measured at 3 months.

RESULTS

Sixty-one patients were included. All patients were pseudophakic after RD repair. The mean preoperative and postoperative BCVA (logarithm of the minimum angle of resolution) at 3 months was 1.41 (±0.71) and 0.15 (±0.12, range 0.00-0.70). Twenty-six patients with SFFH of ≤1500 µm were available for repeat OCT measurements. The variation in SFFH was proportional to the SFFH and showed a logarithmic (base 2) association (r=0.50, p=0.01). Patients were therefore grouped according to their SFFH as group 1: 1-100 µm, group 2: 101-300 µm, group 3: 301-700 µm, group 4: 701-1500 µm and group 5: 1501-3100 µm. BCVA at 3 months significantly reduced with increasing SFFH from 0.04 (±0.03) in group 1 to 0.28 (±0.15) in group 5 (p<0.001) but was not associated with age (p=0.77), preoperative BCVA (p=0.39), duration of LCV (p=0.63) or use of perfluorocarbon liquids (p=0.88). Forty-five patients had SFFH ≤1500 µm and achieved 0.10 (±0.07, range 0.00-0.30) logMAR.

CONCLUSION

Visual acuity following PPV for macula-off RD is related to preoperative SFFH regardless of the duration of symptomatic LCV within the first week.