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Catherine P. Garcher, Marie-Pierre Delolme, Brice Dugas, Jr., Frédéric Nicot, Alain Gaudric, Alain M. Bron; Anatomical And Functional Macular Changes After Rhegmatogenous Retinal Detachment With Macula Off. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6162.
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To evaluate the correlation between morphologic changes in the outer retina and visual function after successful repair of rhegmatogenous retinal detachment with macula off.
Thirty patients (30 eyes) with successful repair of rhegmatogenous retinal detachment (RD) after macula off and a minimum 6-month follow-up after the surgery were examined. Preoperative characteristics of the RD (visual acuity and duration) were collected. Postoperative visual acuity measurement with ETDRS scale and fundus autofluorescence (FAF) were performed. Spectral-Domain Optical Coherence Tomography (HRA OCT) of outer retina was performed to analyse the number of disrupted IS/OS junctions, the hypo-reflectivity in the photoreceptor outer segments (PROS), the discontinuation of the external limiting membrane and the presence of hyper-reflective spots in the outer nuclear layer.Finally, microperimetry associated with OCT/SLO was performed to measure the foveal and macular sensitivity as well as the quality of the foveal and macular fixation.
Twenty out of thirty eyes presented microstructural changes within the photoreceptor layer (66.7%). Of these, half of patients (50%) had more than one lesion. Disrupted IS/OS junction was noted in 16 out of 30 eyes (53.3%), irregular hypo-reflectivity in the photoreceptor outer segments (PROS) was described in 17 eyes (56.7%), external limiting membrane was discontinued in 10 eyes (33.3%) and hyper-reflective spots in the outer nuclear layer were observed in 5 eyes (16.7%). FAF changes were detected in only 16.7% of cases. Abnormalities in the IS/OS junction were significantly associated with lower foveal, macular sensitivity, thinner PROS thickness and with extensive photoreceptor changes, p=0.003, p=0.014, p=0.006, p<0.0001, respectively. The PROS thickness was 57.2 ± 6.8 µm and was strongly associated with the number of photoreceptor alterations in SD-OCT (p<0.0001). PROS thickness was also correlated with foveal sensitivity but not with the best corrected visual acuity, p=0.017 and p=0.312, respectively.
SD-OCT and microperimetry seemed to be appropriate tools to determine the visual and the anatomic recovery of the macula after surgery.
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