Session Title: Free Paper Session 1: Vitreoretinal Surgery I
Session Date/Time: Thursday 07/09/2017 | 09:00-10:30
Paper Time: 09:24
Venue: Room 111
First Author: : N.Arend GERMANY
Co Author(s): : F. Lob S. Dabov R. Schumann A. Kampik S. Priglinger A. Wolf
To evaluate OCT morphological and clinical parameters 3 years after primary macula-on and macula-off rhegmatogenous retinal detachment repair and the role of the foveal bulge sign.
20 patients with primary rhegmatogenous, 14 with macula on, 6 with macula off status, were included in the study after informed consent. OCT, complete ophthalmologic examination and best corrected visual acuity (BCVA) were performed prior to retinal detachment surgery and 3 years after successful retinal detachment repair.
On OCT, macula status was assessed as well as central retinal thickness (CRT), the thickness of each single retinal layer (NFL, GCL, IPL, INL, OPL, ONL) and the central choroidal thickness were measured. Additionally, the integrity of the inner segment- outer segment- junction (IS/OS), the cone-interdigitation-zone (CIZ) and the external limiting membrane (ELM), presence of the foveal bulge, foveal depression, epiretinal membranes and intraretinal fluid were determined pre- and postoperatively. We compared patients with macula on and macula off retinal detachments, patients with a postoperative visual acuity of less or more than 0.3logMAR and patients with and without a foveal bulge postoperatively. Significant differences between the groups were determined using the Mann Whitney test. Results were considered statistically significant when p<0.05.
Comparing study eye with fellow eye, in patients with attached macula, INL was always thicker, ONL and choroid thinner. With detached macula the IPL, INL and OPL were thicker with partly recovery. Macula on patients showed thinner preoperative choroid, INL and IPL and thicker preoperative OPL as macula off. The latter had a worse preoperative BCVA. Postoperative BCVA was not different neither were the integrity of CIZ or postoperative presence of foveal bulge. Patients with postoperative BCVA better than 0.3logMAR had thinner preoperative choroid and better postoperative integrity of CIZ, ISOS and foveal bulge. There was no difference in preoperative macula status, BCVA or retinal layers. Patients with postoperative foveal bulge showed better 3 year BCVA with better pre- and postoperative integrity of CIZ, thinner preoperative NFL and thicker postoperative IPL and INL than patients without a postoperative foveal bulge. Preoperative macula status was not relevant for the postoperative presence of foveal bulge. The postoperative foveal bulge, CIZ and ISOS integrity correlated significantly with postoperative BCVA; the foveal bulge had most impact. It also correlated with postoperative INL and IPL thickness and integrity of CIZ and ISOS. Preoperative integrity of CIZ was however the most relevant factor for foveal bulge.
Depending on preoperative macula status, there are many changes in retinal layers after retinal detachment. The presence of the foveal bulge is the most relevant factor related to good postoperative BCVA after retinal detachment. The preoperative integrity of CIZ seems to be the strongest predictor for the restoration of the foveal bulge. No correlation was found with the preoperative macula status or BCVA.