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Roberto dell'Omo, Stevie Tan, Francesco Barca, Heico M. Bijl, Sarit Y. Lesnik Oberstein, Marco Mura; Evolution Of Partial-thickness Macular Folds Occurring After Vitrectomy For Retinal Detachment Repair. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6357. doi: https://doi.org/.
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To assess the evolution of macular folds occurring after repair of rhegmatogenous retinal detachment (RRD) using spectral-domain optical coherence tomography (sd-OCT) and fundus autofluorescence (FAF).
Prospective observational case series. Sd-OCT and FAF imaging were recorded at 1, 3 and 6 months postoperatively using the Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany) in 20 patients undergone 25-gauge pars plana vitrectomy and 20% sulfur hexafluoride gas injection for primary macula-off RRD repair. All operations were performed at a single tertiary referral center.Baseline visual acuity (VA), preoperative lens status, duration, location and extension of RRD, postoperative VA and assessment of metamorphosia subjectively perceived by the patients (based on a scale ranging from grade 0 [absence of metamorphopsia] to grade 3 [metamorphopsia disturbing the performance of daily tasks]) were recorded at each follow-up visit. Evolving features of macular folds and their relation with visual acuity and metamorphopsia were assessed.
Over the follow-up period thick hypoautofluorescent lines progressively evolved to thick hyperautofluorescent lines and to thin hyperautofluorescent lines to eventually disappear. In 6 cases assessment with FAF at month 6 was precluded by the development of dense cataract. Sd-OCT findings consisted of outer and inner retinal folds (ORFs and IRFs), inner retinal wrinklings, skip reflectivity abnormalities of photoreceptors inner segment/outer segment (IS/OS) junction, disruption of the lines corresponding to external limiting membrane and IS/OS, epiretinal membranes (ERMs) and intra/subretinal fluid. During the follow-up all the OCT changes, except for ERM, showed a tendency to resolve. Average metamorphopsia score significantly decreased from 2.55 at 1-month follow-up to 1.65 and 1.35 at 3 and 6-month follow-up, respectively (Friedman test, P <0.001). Among the studied sd-OCT abnormalities, the only independent variable related to grade 3 metamorphopsia was the presence of ORFs (logistic regression analysis, P=0.01).
ORFs and IRFs are common findings after repair of macula-off RRD but resolve spontaneously within a few months from operation. ORFs are an important anatomical substrate for postoperative metamorphopsia disturbing the performance of daily tasks. Such severe metamorphopsia normally resolve within 3 months after surgery.
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