Evaluation of early photoreceptor affection following successful retinal detachment surgery

Abstract

Purpose : Recent reports highlighted the importance of the outer retinal layers including external limiting membrane (ELM) and ellipsoid zone (EZ), in visual recovery following rhegmatogenous retinal detachment (RRD) surgery. Relative EZ reflectivity (rEZR) was recently introduced as a quantitative biomarker for photoreceptor integrity in spectral-domain optical coherence tomography imaging. The study aimed to assess the functional relevance of the rEZR following successful RRD repair and its association with the surgical procedure.

Methods : Patients treated for primary RRD repair between April 2021 and 2023 at the Department of Ophthalmology, University of Bonn/Germany, were retrospectively identified. Further inclusion criteria were both absence of other causes for visual impairment and a macular SD-OCT scan of >30 serial scans at six weeks after surgery. The mean rEZR was determined as the peak reflectivity ratio of the EZ to the ELM. Linear models, corrected for age and sex, were used to assess the association of the rEZR with the postoperative best-corrected visual acuity (BCVA). Furthermore, linear-mixed effect models, corrected for patient’s age, sex, macula-on/off RRD, and eccentricity were used to assess the association of the rEZR with the surgical procedure.

Results : A total of 187 patients (median[IQR] age of 60.95[9.7] years) were included. Out of those, 91.4% underwent vitrectomy for RRD repair and 8.6% scleral buckling. The median rEZR in all RRD eyes six weeks after surgery was significantly lower as compared to the healthy fellow eyes (coefficient estimate(CE):-7.65[95%-confidence interval:-17.78;-3.32], p<0.001). Moreover, higher rEZR values were associated with better postoperative BCVA(CE:0.0079[0.005;0.011], p<0.001) as well as with the procedure of scleral buckling(CE:11.99[0.56; 23.43], p<0.04). For vitrectomy cases(n=171), in which heavy liquid(perfluorodecalin) had been used during surgery(n=99), lower rEZR values were detected (CE:-7.44[-14.11;-0,76], p<0.03).

Conclusions : The results indicate a significant association of rEZR with visual function after successful RRD repair and with surgical procedures even after correcting for macula-on/off RRD. A more refined characterization of changes in the photoreceptor integrity over time and its association with specific surgical procedures as well as other surgical (long-term) outcomes is warranted to better understand photoreceptor changes.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.