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  • Title: Foveal microstructure and visual acuity after retinal detachment repair: imaging analysis by Fourier-domain optical coherence tomography.
    Author: Wakabayashi T, Oshima Y, Fujimoto H, Murakami Y, Sakaguchi H, Kusaka S, Tano Y.
    Journal: Ophthalmology; 2009 Mar; 116(3):519-28. PubMed ID: 19147231.
    Abstract:
    PURPOSE: To evaluate foveal microstructural changes in eyes with anatomically successful repair of rhegmatogenous retinal detachments (RRDs). DESIGN: Retrospective, consecutive, observational case series. PARTICIPANTS: Fifty-three eyes of 51 consecutive patients with macula-on RRDs (15 eyes) or macula-off RRDs (38 eyes) after anatomically successful surgical repair. METHODS: A microscopic fundus examination was conducted followed by Fourier-domain optical coherence tomography (FD-OCT) to assess the postoperative foveal microstructure. The correlation between the postoperative best-corrected visual acuity (BCVA) and microstructural findings at the fovea was evaluated. MAIN OUTCOME MEASURES: Images of the foveal microstructure obtained by FD-OCT and the BCVA measured on the same day. RESULTS: We obtained FD-OCT images a mean of 10.3+/-7.3 months (range, 1-25) postoperatively. Foveal anatomic abnormalities were detected in 33 eyes (62%); disruption of the junction between the photoreceptor inner and outer segments (IS/OS) in 23 eyes (43%), of which 9 eyes (39%) had a disrupted external limiting membrane (ELM); residual subretinal fluid in 6 eyes (11%), epiretinal membranes in 12 eyes (23%), and cystoid macular edema in 2 eyes (4%). Disruption of the photoreceptor IS/OS junction was observed only in macula-off eyes, whereas other microstructural abnormalities were observed in both macula-on and macula-off eyes. In preoperative macula-off eyes, the postoperative BCVA was significantly correlated with the integrity of the photoreceptor IS/OS and ELM signals detected by FD-OCT postoperatively (r=0.805; P<0.001). Of the 16 eyes followed by FD-OCT, the photoreceptor IS/OS junction was restored in 7 (64%) of the 11 eyes with a disrupted back-reflection line from the IS/OS junction, but without disrupted ELM signals at the initial examination. Of the 5 eyes with disrupted back-reflection lines from both IS/OS junction and ELM at the initial examination, the photoreceptor layer was not restored completely during the follow-up period in any eyes. CONCLUSIONS: After anatomically successful RRD repair, FD-OCT is a valuable, noninvasive tool for evaluating foveal microstructural changes. The integrity of the photoreceptor IS/OS junction and ELM signals detected by FD-OCT may account for visual restoration in patients with preoperative macula-off RRDs. Preservation of the ELM postoperatively may predict the subsequent restoration of the photoreceptor layer.
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