Anatomy of the Retina After Retinal Detachment Surgery as Measured by Ultrahigh Resolution Optical Coherence Tomography

Abstract

Abstract: : Purpose: Postoperative visual complaints may occur after anatomically successful repair of rhegmatogenous retinal detachments. Reduced postoperative vision may result from epiretinal membranes (ERM), pigment migration, cystoid macular edema (CME), retinal folds, myopic shift, or cataract. Decreased final postoperative visual acuities can occur in the absence of these clinically detectable complications. We employed ultrahigh resolution optical coherence tomography (UHR–OCT) to determine the presence of structural changes in the retina that might explain incomplete visual recovery. Methods: UHR–OCT images through the center of the fovea in twelve patients with visual complaints after retinal detachment surgery were obtained. Patients were either postoperative patients from the New England Eye Center or tertiary referrals. Baseline visual acuity, preoperative lens status, location of retinal detachment, macular involvement, and postoperative visual acuity were recorded. Results: UHR–OCT images were obtained one to ten months postoperatively. Anatomical abnormalities detected included ERM, CME, and pockets of residual subretinal fluid. In addition, disruption of the inner segment–outer segment (IS/OS) junction of the photoreceptors was noted. Conclusions: The higher resolution of UHR–OCT allows imaging of the IS/OS junction which is not measurable by standard OCT3 (Carl Zeiss Meditec). UHR–OCT therefore is able to confirm prior histopathologic findings that damage to photoreceptor outer segments may occur as a consequence of retinal detachment. This may explain poor postoperative visual acuity in eyes with anatomically successful repair.

Keywords: retinal detachment • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • retina: distal (photoreceptors, horizontal cells, bipolar cells)