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S.E. Benson, P.G. Schlottmann, C. Bunce, G.E. Holder, D.G. Charteris; Imaging and Electrphysiology in Unexplained Visual Loss After Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2036.
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Purpose: To assess the structural and functional changes associated with poor visual outcome following successful retinal detachment repair. Methods: Patients were recruited from all Moorfields Eye Hospital vitreoretinal clinics between March and August 2003. Eligible patients had undergone anatomically successful surgery at least 3 months previously and had no identifiable cause on clinical examination for poor vision (6/18 or worse). All patients underwent Optical Coherence Tomography (OCT) 3000 macular scan. Electrodiagnostic testing was performed in those patients with macula–on detachment and normal OCT. Results: 39 patients were recruited: 32 patients had macula–off detachment; 7 patients had macula–on detachment. 23 (72%) of the macula–off patients had normal OCT, 4 had cystoid macular edema, 2 had localised subfoveal fluid and 1 patient had a lamellar macular hole. None of these pathologies were evident on clinical examination. The remaining 2 patients had epiretinal membrane. Of the macula–on patients, 1 had cystoid macular edema. Another had previously undergone surgery for epiretinal membrane peel; residual membrane was visible clinically and on OCT. Five of the 7 macula–on patients had normal OCT. One of these had silicone oil in situ at the time of OCT; the remaining 4 underwent electrophysiological assessment. Three had moderate or severe macular dysfunction; in these there was peripheral retinal dysfunction of mild, mild–moderate and moderate severity. The fourth patient, with acuity loss after removal of silicone oil, had electrophysiological evidence of optic nerve dysfunction. Conclusions: Unexplained poor visual acuity following anatomically successful detachment surgery requires both structural and functional evaluation. OCT was effective at demonstrating pathology not visible on fundus examination. Electrophysiological evaluation identified the origin of the visual dysfunction in four patients without macular involvement and with normal OCT examination.
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