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Anatomical and functional macular changes after rhegmatogenous retinal detachment with macula off
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Edité par CCSD ; Association for Research in Vision and Ophthalmology -
International audience. Purpose: To evaluate the correlation between morphologic changes in the outer retina and visual function after successful repair of rhegmatogenous retinal detachment with macula off. Methods: Thirty patients (30 eyes) with successful repair of rhegmatogenous retinal detachment (RD) after macula off and a minimum 6-month follow-up after the surgery were examined. Preoperative characteristics of the RD (visual acuity and duration) were collected. Postoperative visual acuity measurement with ETDRS scale and fundus autofluorescence (FAF) were performed. Spectral-Domain Optical Coherence Tomography (HRA OCT) of outer retina was performed to analyse the number of disrupted IS/OS junctions, the hypo-reflectivity in the photoreceptor outer segments (PROS), the discontinuation of the external limiting membrane and the presence of hyper-reflective spots in the outer nuclear layer.Finally, microperimetry associated with OCT/SLO was performed to measure the foveal and macular sensitivity as well as the quality of the foveal and macular fixation. Results: Twenty out of thirty eyes presented microstructural changes within the photoreceptor layer (66.7%). Of these, half of patients (50%) had more than one lesion. Disrupted IS/OS junction was noted in 16 out of 30 eyes (53.3%), irregular hypo-reflectivity in the photoreceptor outer segments (PROS) was described in 17 eyes (56.7%), external limiting membrane was discontinued in 10 eyes (33.3%) and hyper-reflective spots in the outer nuclear layer were observed in 5 eyes (16.7%). FAF changes were detected in only 16.7% of cases. Abnormalities in the IS/OS junction were significantly associated with lower foveal, macular sensitivity, thinner PROS thickness and with extensive photoreceptor changes, p=0.003, p=0.014, p=0.006, p<0.0001, respectively. The PROS thickness was 57.2 ± 6.8 µm and was strongly associated with the number of photoreceptor alterations in SD-OCT (p<0.0001). PROS thickness was also correlated with foveal sensitivity but not with the best corrected visual acuity, p=0.017 and p=0.312, respectively. Conclusions: SD-OCT and microperimetry seemed to be appropriate tools to determine the visual and the anatomic recovery of the macula after surgery.
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