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Junyeop Lee, Jang Hwan Ahn, Jehwi Jeon, Min Sagong, Junhyuk Son, Sooncheol Cha, Young Hee Yoon; Retinal ischemia limits visual recovery in rhegmatogenous retinal detachment. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1594.
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© ARVO (1962-2015); The Authors (2016-present)
Factors determining the reversibility of visual function in retinal detachment are yet to be clearly defined. We performed a retrospective study to evaluate the hemodynamic changes in the detached and reattached retina and its association with post-operative visual recovery in rhegmatogenous retinal detachment (RRD).
This study included 52 eyes with primary RRD which underwent successful vitrectomy or scleral buckling by a single surgeon. Pre- and post-operative ultra-widefield fluorescein angiography (UWF FA), spectral domain-optical coherence tomography (SD-OCT), and post-operative OCT angiography (OCTA) were obtained. The integrity of ellipsoid zone (EZ) was evaluated in post-operative SD-OCT. Using the OCTA, vascular flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the reattached retina were compared with those of the contralateral unaffected eye.
In the UWF FA, all RRD eyes presented areas of capillary hypo- or non-perfusion at the detached periphery, venous stasis and diffuse paravascular leakage at the detached retina, all of which were partially recovered after reattachment. In the 26 eyes with macula-off RRD, less flow density of DCP in post-operative OCTA was strongly correlated with longer duration of detachment (r = -0.888, p< 0.001), greater EZ disruption in SD-OCT, (r = -0.923, p < 0.001) and the poor visual recovery (r = -0.935, p < 0.001). In contrast, the flow density in SCP was not associated with post-operative visual outcome or duration of detachment.
RRD resulted in hypo-perfusion, venous stasis, and associated vasculopathies at the detached retina, which were restored after the reattachment. Because the low blood flow triggers the regresion of capillaries, the longer duration of low-flow in the detached retina, the more capillary loss in DCP leading to greater photoreceptor damage and poor visual outcome in the eyes with macula-off RRD. This study suggests that retinal ischemia serves as a major cause of irreversible photoreceptor cell death in RRD. Thus, early reattachment and reperfusion are required for the prevention of visual impairment in the macula-off RRD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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