Correlation Of Foveal Microstructure Changes On SD-OCT And Visual Function After Retinal Detachment Repair

Objective: To evaluate the correlation between morphologic changes inthe macular foveal and visual function after scleral buckling procedure ofrhegmatogenous retinal detachment（RRD） by using the spectral-domainoptical coherence tomography（SD-OCT）.Methods: Forty-three eyes of43patients who were diagnosed as RRD inour hospital (the Department of Ophthalmology of the Second Hospital ofHebei Medical University) met the selection. All eyes received scleralbuckling combined with cryoretinopexy procedure and the retina wassuccessfully reattached. A thorough ophthalmologic examination includingbest correct visual acuity(BCVA)，slit-lamp biomicroscopy, binocular indirectophthalmology, SD-OCT scanning and perimetry were performedpreoperatively, and SD-OCT scanning was performed during all subsequentfollow-up visits at3d,1mon,3mon,6mon postoperatively. Perimetry wasperformed at1mon,3mon,6mon postoperatively. Healthy fellow eye controlgroup:39eyes SD-OCT and perimetry routine inspection. The height of thesubretinal fluid, foveal central retina thickness, and outer nuclear layer（ONL）thickness were measured using SD-OCT. The morphologic changes in themacular foveal and visual function were also evaluated. We compared whetherthe age or hole location has effect on the postoperative SRF absorption.Results:1Preoperative SRF height was885.05±493.28μm,and100%patientsshowed residual SRF in different degree on SD-OCT.As time goes by, SRFwas absorbed slowly.93%(39eyes) had SRF at postoperative1month,and77.8%(33eyes) at3months，46.5%(20eyes) at6months. The height of SRFwas correlated with preoperative visual acuities（r=0.817，P=0.001）.Postoperative SRF absorption in different age groups(≤30years，＞ 30years) has statistically significant（P=0.12），SRF absorption in low agegroup was fast. Preoperative the height of the detached retina in differentlocation of hole groups has statistically significan（tP＜0.01）,the height of thedetached retina with superior hole was high than the ones with inferior hole.Meanwhile, the height of the detached retina at different time points hasstatistically significant （F=42.28，P＜0.01），SRF absorption in patients withinferior hole was quickly than the ones with superior hole.There were three patterns of SRF on postoperative SD-OCT sans(1)aconfluent bleb，(2)multiple blebs，（3）a single bleb.2There are three changes of detached retina on preoperative SD-OCTscans:(1)a normal foveal contour was preserved,(2)diffuse edema in the outernuclear layer with cystoids cavities, and (3) diffuse edema in the outer nuclearlayer with cystoids cavities, undulations of outer retinal layer.3Preoperative the mean central retinal thickness（128.88±41.63μm） inthe RRD eyes resulted significantly lower（P＜0.01）compared with thehealthy fellow eye（181.17±10.36μm）.The mean thickness at six months（149.55±45.75μm） was significantly increased compared withpreoperative(P＜0.05)，but compared with healthy follow eye it still remainedthinner（P＞0.05）. The central retinal thickness was strongly correlated withpostoperative BCVA(r=0.028；P＜0.05).4Preoperative the mean ONL thickness（74.95±25.21μm） in the RRDeyes resulted statistically lower（P＜0.05）compared with the healthy felloweye（102.28±11.63μm）.The mean thickness at six months(86.28±19.26μm)was increased compared with preoperative, and has no statisticallydifference(P＞0.05），and compared with healthy follow eye it has statisticallydifference(P＜0.05）. The ONL thickness was correlated with postoperativeBCVA (r=0.521；P=0.035).5There are four types of microstructure abnormalities in the foveal aftersuccessful reattachment：（1） disruption of ELM， IS/OS junction andIL,(2)ELM was preserved, IS/OS junction and IL were disrupted,(3)ELM andIS/OS junction were intact, IL was disrupted, and(4)All of the three were intact.6Preoperative mean perimetry sensitivity（11.74±10.04dB）in the RRDeyes resulted lower （P＜0.05） compared with the healthy fellow eye（29.23±3.45dB），at six months after surgery it has no difference with thehealthy fellow eye.The mean perimetry sensitivity at six months wasincreased compared with preoperative(P＜0.05)，illustrated that with retinalreattached，visual function gradually restored.Conclusions:1Postoperative persistent SRF, preoperative central foveal thickness andONL thickness were correlated with a delayed visual outcome in macula-offRRD patients.2The integrity of ELM, IS/OS and IL maybe important predictors ofpostoperative visual outcome after RRD repair.