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Hemang Pandya, Asheesh Tewari, Gary Abrams; Assessing Macular Morphology with Spectral Domain-Optical Coherence Tomography Following Rhegmatogenous Retinal Detachment Repair. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2869. doi: https://doi.org/.
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Rhegmatogenous Retinal Detachment (RRD) is a potentially blinding condition that results in anatomical distortion of the retina. RRD can be repaired with surgery, such as scleral buckle (SB) and/or pars plana vitrectomy (PPV). Despite achieving good anatomical outcomes, a potentially poor prognosis remains. Predictors of visual outcomes following RRD repair include pre-operative best correct visual acuity (BCVA), foveal detachment, cystoid macular edema (CME), epiretinal membrane (ERM), external limiting membrane (ELM) and inner/outer segment (IS/OS) integrity, and proliferative vitreoretinopathy (PVR). However, microscopic changes cannot be objectively assessed on fundoscopy. Spectral-Domain Optical Coherence Tomography (SD-OCT) is an important diagnostic and monitoring tool for macular disease, as it images retinal anatomy essentially at a histological level. We aspire to assess these microscopic changes using SD-OCT to investigate visual prognosis.
Retrospective chart review was performed on 46 eyes (of 46 patients) with RRDs that had surgery between January 2010 and January 2012. Patients were evaluated for clinical course, surgical intervention and anatomical outcomes. Inclusion criteria included diagnosis of RRD who were treated surgically (SB or PPV alone, or SB with PPV), and have post-operative SD-OCT. Exclusion criteria included co-existing macular pathology, active uveitis, and/or previous RRD.
Forty-six eyes of 46 patients were included (mean age: 56.7 years). All patients had post-operative SD-OCT at an average time of 9.79 months (range: 1-29 months). There were 18 macula-on (39.1%) and 28 macula-off RRDs (60.9%). The comparison of macula status to post-operative outcomes is presented in Figure 1. The comparison of surgical approach to post-operative outcomes is presented in Figure 2.
SD-OCT holds promise for documenting alterations in macular morphology following RRD. CME, ERM, and PVR rates after RRD repair were statistically higher with combined SB/PPV than primary SB. ELM and IS/OS junction disruption rates were not statistically different between primary SB and combined SB/PPV groups. Prospective studies are warranted to further elucidate long-term visual prognosis.
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