Reversibility of retinal vascular insufficiency determines visual prognosis in rhegmatogenous retinal detachment

Session Details

Session Title: Free Paper Session 17: Imaging II

Session Date/Time: Saturday 09/09/2017 | 08:00-09:30

Paper Time: 08:18

Venue: Room 120

First Author: : J.Lee SOUTH KOREA

Co Author(s): :    M. Sagong   Y. Yoon                          

Abstract Details

Purpose:

To evaluate the hemodynamic changes in the detached and reattached retina and its association with postoperative visual recovery in rhegmatogenous retinal detachment (RRD).

Setting:

Retrospective case series study was conducted at the department of ophthalmology Yeungnam University, Daegu, Korea, and Asan Medical centre, Seoul, Korea.

Methods:

This study included 52 eyes with primary RRD which underwent successful vitrectomy or scleral buckling by a single surgeon. Pre- and postoperative ultra-wide field fluorescein angiography (UWF FA), spectral domain-optical coherence tomography (SD-OCT), and postoperative OCT-Angiography (OCT-A) were obtained. We evaluated the integrity of ellipsoid zone (EZ) in postoperative SD-OCT. Using the OCT-A, vascular flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the reattached retina were compared with those of the contralateral unaffected eyes.

Results:

In the UWF FA, all RRD eyes presented areas of capillary hypo- or non-perfusion, venous stasis and diffuse paravascular leakage, all of which were partially recovered after reattachment. In the 26 eyes with macula-involving RRD, less flow density of DCP in postoperative OCT-A was strongly correlated with longer duration of detachment (r = -0.888, p<0.001), greater EZ disruption in SD-OCT, (r = -0.923, p<0.001) and the poor visual recovery (r = -0.935, p<0.001). In contrast, the flow density in SCP was not associated with postoperative visual outcome or duration of detachment.

Conclusions:

RRD resulted in hypo-perfusion, venous stasis, and associated vasculopathies, which were partially restored after the reattachment. Because the low blood flow triggers the regression of capillaries, the longer duration of low-flow in the detached retina, the more capillary loss in DCP leading to greater photoreceptor damage and poor visual outcome in the eyes with macula-involving RRD. This study suggests that decreased blood flow in the retinal capillaries exacerbates photoreceptor cell death in RRD. Thus, early reattachment and reperfusion are required for the prevention of irreversible visual impairment in the macula-involving RRD.

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