Correlation between outer retinal foveal morphology and visual outcome following repair of rhegmatogenous retinal detachment with proliferative vitreoretinopathy

Abstract

Purpose : Visual outcomes following repair of rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) are frequently poor. We herein correlate visual recovery with spectral-domain optical coherence tomography (SD-OCT) findings following successful repair of RRDs complicated by PVR. This is previously unreported.

Methods : This was an observational, non-comparative, cross sectional study of 22 eyes with fovea-involving RRDs complicated by PVR Grade C. All eyes achieved anatomical success at 6-months post-vitrectomy. Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) measurement and SD-OCT examination were performed at 6 months postoperatively.
The following features were evaluated using SD-OCT: central foveal thickness; macular volume; outer nuclear layer (ONL) thickness; photoreceptor outer segment (PROS) thickness; discontinuity of the external limiting membrane (ELM), discontinuity of the photoreceptor ellipsoid zone, hyperreflections within the outer nuclear layer and disruption of the PROS layer.
The correlation between post-operative BCVA and SD-OCT findings were investigated using univariate linear regression and forward stepwise multiple variable regression analyses. ANOVA was used to compare means between groups.

Results : Median BCVA and median PVR grade at presentation was zero letters and grade C3, respectively. Discontinuity of the ELM was observed in 6 eyes (27.3%) and the ellipsoid layer was disrupted in 15 eyes (68.2%). Mean ONL thickness was 96.2µm with ONL hyperreflection found in 11 eyes (50.0%).
ELM discontinuity and ONL thickness showed a strong correlation with final BCVA (r² = 0.484, p< 0.001; r²= 0.451, p= 0.001 respectively). ONL hyperreflections were moderately correlated with final BCVA (r²⁼ 0.256, p=0.016). Ellipsoid layer disruption was not associated with visual outcome.
Multiple variable regression revealed ELM discontinuity as a strong predictor of final BCVA (r²⁼0.479, p= 0.006). Mean final BCVA in eyes with and without an intact ELM was 65.8 (+/- 2.7) letters versus 44.3 (+/- 3.6) letters, respectively (p< 0.001).

Conclusions : This study suggests that the integrity of the ELM may be an important predictor of postoperative visual recovery after anatomically successful repair of RRDs complicated by PVR.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.